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.
Carpal Tunnel Syndrome Treatment at Graham Plastic Surgery
Dr. Graham is Hand Fellowship Trained at the renowned University of Louisville Hand Center and 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:
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
Carpal Tunnel Syndrome Treatments
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.
Risks associated with this surgery can include:
- Swelling, stiffness, and pain
- Nerve Damage
- Wrist or thumb base pain “pillar pain”
- Residual numbness in fingers
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.