WHAT IS CARPAL TUNNEL SYNDROME?
Carpal tunnel syndrome is a condition in which too much pressure is placed on the median nerve. The median nerve is a nerve that supplies sensation to your thumb, index, long, and ring fingers. It also activates the muscles at the base of the thumb. There nerve gets compressed as it passes through the carpal tunnel, which is the space in your wrist surrounded by your wrist bones and a crossing ligament(white structure in picture to the right). Pressure on the nerve occurs secondary to fluid retention, swelling of tissue around the nerve, and inflammation. In many cases the cause is unknown.
WHAT ARE THE SYMPTOMS OF CARPAL TUNNEL SYNDROME?
- Numbness and tingling in the first 3-4 fingers, with the index and middle finger most often affected.
- Numbness and pain at night, often awakening you from sleep
- Pain and tingling with activities such as grip, driving a car, holding a cell phone, or washing hair
- Decreased pinch or grip strength with tendency to drop items
HOW IS CARPAL TUNNEL SYNDROME DIAGNOSED?
In our practice carpal tunnel syndrome is most often diagnosed by history and physical exam. The American Academy of Orthopedic Surgery published in their 2016 guidelines that Nerve Conduction Testing was a poor test for diagnosing carpal tunnel syndrome. The test has a reportedly 30-40% false negative rate meaning that it is wrong about carpal tunnel 30% of the time. Rather than rely on a poor test, that is also painful for the patient, we rely on physical exam and steroid testing to confirm the diagnoses of carpal tunnel syndrome. Furthermore, you can also take the quiz below, called the CTS-6, to diagnose yourself with carpal tunnel syndrome. This test, published in the Journal of Bone and Joint Surgery in 2008 is found to be as accurate in diagnosing carpal tunnel as receiving formal nerve conduction testing.
WHAT IS THE TREATMENT FOR CARPAL TUNNEL SYNDROME?
In most cases, the initial treatment is nonoperative. A trial of splinting and steroid injections is attempted at first. Most patients with carpal tunnel syndrome will respond to a steroid injection. The length of response to this treatment varies. In some patients it is curative and in others it is very short acting. Recent data from the Mayo Clinic suggests a 30% cure rate with steroid injection alone.
Operative-Open versus Closed Carpal Tunnel Release
Eventually, many patients require surgery. In this case Dr. Graham can perform either endoscopic carpal tunnel release or open carpal tunnel release. There are advantages and disadvantages to both techniques. The main advantage of endoscopic carpal tunnel release is faster recovery and less pain, but this is more expensive. The main advantage of open carpal tunnel release is that it can easily and safely be performed in the office, literally saving $3000 to $4000 on average. This is substantial for those with high deductibles or self pay patients.
Endoscopic Versus Open Carpal Tunnel Release
Type of Surgery Surgery Location Pain from Surgery Recovery Time Surgical Safety Overall Complication Rate Results at 3 months Cost
Open Carpal Tunnel Release Office More 4-12 weeks Same Higher Same $450-850
Endoscopic Carpal Tunnel Release Hospital Less 1-4 weeks Same Lower Same $2500-5000
WHY CHOOSE DR GRAHAM TO TREAT YOUR CARPAL TUNNEL SYNDROME?
As he is Hand Fellowship Trained at the renowned University of Louisville Hand Center Dr. Graham is an expert in treating carpal tunnel syndrome. He can evaluate and treat your condition, often without painful nerve conduction tests or even surgery. Dr. Graham is facile with both the open and endoscopic sugical techniques. He is able to offer the open carpal tunnel release technique in his office surgical suite, saving patients time and money, or he can perform the most advanced endoscopic carpal tunnel release, which is shown below:
WHAT ARE THE MAIN RISKS OF CARPAL TUNNEL SURGERY?
• Swelling, stiffness, and pain
• Nerve Damage
• Wrist or thumb base pain “pillar pain”
• Residual numbness in fingers
WHAT IS THE CARPAL TUNNEL RECOVERY?
When endoscopic carpal tunnel release is performed recovery time is minimal. We do not splint and allow the patient to use the hand as much as they want. The majority of patients can return to work in the first 1-3 days. However, patients who perform heavy labor may require 4-5 weeks to recover. Most self employed patients return to work almost right away. Open carpal tunnel release may require 3-4 weeks recovery time, with those who perform heavy labor requiring 2-3 months to recover. Driving can resume the next day if the patient is comfortable and not taking narcotics.