Two Basic Types Of Carpal Tunnel Surgery
Carpal tunnel release surgery can either beopenorendoscopic. Both aim to cut the ligament holding the wrist bones together.
Open carpal tunnel release surgerymeans the surgeon creates a 2-3 inch slit on the palm. The surgeon cuts the ligament, and then sutures the skin closed. This results in a significantly long scar on the palm.
- Theadvantageof this technique is that the surgeon can clearly see all of the structures in the hand. That means theres less chance to accidentally lacerate an important structure like a nerve or blood vessel.
- Thedisadvantageof the open technique is that theres much more hand trauma. This means more postsurgical pain and longerrecovery and aftercare.
Endoscopic carpal tunnel release surgeryis a little different. It means a surgeon uses an endoscope to see inside the carpal tunnel space rather than opening the skin over the palm. The surgery uses a thin, flexible tube containing a camera guided through a small incision in the wrist.
Sometimes the surgeon makes two small holes one in the wrist and one in the palm. This is calleddouble portal endoscopic carpal tunnel release surgery.
- Theadvantageof endoscopic surgery is that the surgeon cuts the ligament without having to make a large incision. This means less trauma. And less trauma means less postsurgical pain and faster recovery.
Physical Therapy After Surgery
If the evaluation reveals that your CTS is more severe, or if your symptoms persist, your physical therapist may refer you to consult with a surgeon. If surgery is needed, the surgeon will release the band of tissue that forms the roof of the carpal tunnel. This will decrease the pressure on the median nerve.
Physical therapy treatment is important after surgery to:
- Prevent scar tissue formation.
- Help restore strength to the wrist.
- Help you learn to change habits that may have led to symptoms in the first place.
Your physical therapy treatment after surgery may include:
- Scar management to keep the skin supple and flexible.
- Exercises to glide the nerve within the healing tunnel.
- Stretching exercises to improve mobility of the wrist and fingers and improve function.
- Strengthening exercises to improve the strength of the wrist and hand muscles and improve function.
- Education about proper posture and wrist position to avoid carpal tunnel compression in home/leisure activities.
- A work site visit or mock-up to show you proper workstation set-up. This can help with posture and positions to prevent CTS from recurring. It also can reduce your risk for developing other nerve injuries.
Drug Treatment And Surgery
In addition to wearing splints and other comfort measures, prescription medications or injections are available.
Oral corticosteroid medication may decrease inflammation and swelling, which might help to reduce pressure on the median nerve. Corticosteroid medication is also available as an injection into the wrist. Injections seem to be more effective than oral corticosteroids for CTS.
No significant evidence supports the use of non-steroidal anti-inflammatory drugs to treat CTS.
Conventional treatments for CTS should take place under the guidance of a doctor.
For people who develop CTS during pregnancy, symptoms usually resolve 6 to 12 weeks after giving birth. Some specialists recommend putting a splint on the wrist while sleeping.
Sometimes, if severe compression is occurring on the median nerve, it may be causing nerve damage or muscle wasting that requires further treatment.
The treating doctor may recommend surgery if CTS is severe and if non-surgical treatments do not help. Surgical treatment of CTS does appear to have the best outcome. Studies have shown that 6 to 12 months after surgery, CTS improves more than it would with just a splint or some other non-surgical treatment.
The two types of surgery available for CTS are:
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Physical Activity And Exercise
Several studies have shown a reduction in carpal tunnel symptoms when patients were involved in an exercise program, particularly vigorous physical activity. Jogging, swimming, playing sports, biking, even walking around the neighborhood are all physical activities which are good for you, and your carpal tunnel!
Symptoms Of Carpal Tunnel Syndrome
Carpal tunnel symptoms tend to affect your thumb and fingers . Symptoms include:
- a tingling feeling or pins and needles
- weakness and finding it difficult to grip
- pain or a burning feeling
You can have carpal tunnel symptoms in both hands or just one. It can start to affect your whole hand and may also spread up your arm. Your symptoms may be mild at first, but they may gradually get worse. You can get carpal tunnel symptoms at any time but theyre often worse at night and may wake you up. Certain activities may also trigger your symptoms in the day.
Your carpal tunnel syndrome symptoms may feel better if you shake your wrist or change its position.
If you have any of these symptoms, contact your GP for advice.
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Over The Counter Medications
If your carpal tunnel symptoms are causing you to experience pain, using over the counter medications such as ibuprofen and aspirin might help. These medications can help to alleviate any problem that you are experiencing. Additionally, these over the counter medications help to reduce inflammation around the nerves, which is likely what is causing you to experience pain.
Another option is to purchase topical menthol. There are several types of topical pain medications that you can use. Aspercreme and Biofreeze can help to alleviate some of the pain that you might have as a result of carpal tunnel. It is essential to follow the directions on the package and to talk to your doctor about different medications that you might use for your pain.
How Is It Treated
Mild symptoms usually can be treated with home care. You can:
- Stop activities that cause numbness and pain. Rest your wrist longer between activities.
- Ice your wrist for 10 to 15 minutes 1 or 2 times an hour.
- Try taking non-steroidal anti-inflammatory drugs to relieve pain and reduce swelling.
- Wear a wrist splint at night. This takes pressure off your median nerve.
The sooner you start treatment, the better your chances of stopping symptoms and preventing long-term damage to the nerve.
You also may need medicine for carpal tunnel syndrome or for a health problem that made you likely to get carpal tunnel syndrome.
Surgery is an option. But it’s usually used only when symptoms are so bad that you can’t work or do other things even after several weeks to months of other treatment.
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Carpal Tunnel Syndrome Exercises
The right exercises are useful compliments to another CTS treatment. Exercises along with the right treatment, proper activity modification and wrist splinting can hasten the recovery process.
Here is a generic exercise that you can do anytime, anywhere. This exercise is developed by Dr. Housang Seradge at the University of Oklahoma Orthopaedic & Reconstructive Research Foundation.
Heres another set of exercises from University of Maryland Medical Center for carpal tunnel syndrome. These exercises work to strengthen the wrist, hands, arms and shoulders to help cure and avoid carpal tunnel syndrome.
Core Wrist Exercises
- Hold one hand straight up shoulder-high with your fingers together and palm facing outward.
- With the other hand, bend the hand you are exercising backward with the fingers still held together and hold for 5 seconds.
- Spread your fingers and thumb open while your hand is still bent back and hold for 5 seconds. Repeat five times with each hand.
Could Your Job Be To Blame
Its a common belief that frequent typing can lead to carpal tunnel syndrome. But its actually three times more common among assembly line workers than it is among data-entry personnel and frequent use of vibrating hand tools increases the risk. In contrast, one study found that even heavy computer use up to seven hours a day did not make people more likely to develop carpal tunnel syndrome.
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Helpful Life Hacks For Carpal Tunnel Pain
When you have the wrist or hand pain and tingling of carpal tunnel syndrome, it may seem like surgery is the only answer. But there are measures you can take to either avoid or postpone surgery and still have good quality of life.
1.Give wrists a restOne of the risk factors for carpal tunnel syndrome is repetitive or extreme wrist motion, so simply resting the wrists and keeping them in a neutral position as much as possible can ease pain and numbness.
2.Use a wrist braceBracing the wrist is one of the most reliable ways to stabilize the wrist and ease carpal tunnel pain. When selecting a brace, choose a structured, firm option that will immobilize the wrist, as opposed a flexible one made of neoprene or elastic.
3.Elevate hands, especially during sleepElevating the hands and wrists can help ease inflammation, particularly at night. This can be done by sleeping on your back and propping your wrists up on pillows. Since keeping your arms straight can also help, try wrapping a towel or ace bandage around your elbows.
5.Ask about job rotationIf your job involves activities such as repetitive assembly line work, talk with your employer about the possibility of rotating tasks to give your wrists and hands a rest.
Shake Away The Carpal Tunnel Pain
Wrist pain can literally be shaken away. Shaking the affected hands out can help provide instant pain relief, especially during flare-ups, anytime throughout the day. A gentle shake can work for patients with limited mobility. Gradually increasing the shaking force can relieve pain and prevent wrists from experiencing extra strain.
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What Causes Carpal Tunnel Syndrome
CTS happens when the carpal tunnel inside your wrist swells and squeezes 1 of your nerves .
You’re more at risk if you:
- are overweight
- are pregnant
- do work or hobbies that mean you repeatedly bend your wrist or grip hard, such as using vibrating tools
- have another illness, such as arthritis or diabetes
- have a parent, brother or sister with CTS
- have previously injured your wrist
Page last reviewed: 16 February 2021 Next review due: 16 February 2024
How Can Carpal Tunnel Syndrome Be Prevented
Carpal tunnel syndrome can be difficult to prevent. The condition can be caused by so many different activities in a persons daily life that prevention can be challenging. Workstation changesproper seating, hand and wrist placementcan help decrease some factors that can lead to carpal tunnel syndrome. Other preventative methods include:
- Sleeping with your wrists held straight.
- Keeping your wrists straight when using tools.
- Avoiding flexing and extending your wrists repeatedly.
- Taking frequent rest breaks from repetitive activities.
- Performing conditioning and stretching exercises before and after activities.
- Monitoring and properly treating medical conditions linked to carpal tunnel syndrome.
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What Are The Causes Of Carpal Tunnel Syndrome
Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture an overactive pituitary gland an underactive thyroid gland and rheumatoid arthritis. Other factors that may contribute to the compression include mechanical problems in the wrist joint, repeated use of vibrating hand tools, fluid retention during pregnancy or menopause, or the development of a cyst or tumor in the canal. Often, no single cause can be identified.
How Carpal Tunnel Syndrome Happens
Today we understand a lot more about carpal tunnel syndrome than we did a decade ago. It happens due to malfunctions in the chemistry of the wrist’sflexor tendons. These tendons are the ropy structures running from the hand to the forearm, on the palm side.
The flexor tendons are responsible for moving your fingers and producing grasping actions. Normally, the tendons glide effortlessly next to each other. But when they malfunction, they no longer provide smooth movement.The key to ALL carpal tunnel pain relief is to make tendons glide smoothly again.
The following are the 3 primary steps that produce carpal tunnel syndrome.
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What Increases Your Risk
Things that put you at risk for carpal tunnel syndrome include:
- Health problems or illnesses that can cause arm pain or swelling in the joints and soft tissues in the arm, or reduce the blood flow to the hands. These include obesity, rheumatoid arthritis, diabetes, lupus, hypothyroidism, and multiple sclerosis.
- Being female. Women between the ages of 40 and 60 have the highest risk. Pregnant women near the end of their pregnancies often have short-term symptoms. Women taking birth control pills, going through menopause, or taking estrogen are also thought to be at risk.
- Hand and wrist movements and activities that require repeated motions, especially in awkward positions.
- Smoking. It may contribute to carpal tunnel syndrome by affecting the blood flow to the median nerve.
- Broken wrist bones, dislocated bones, new bone growth from healing bones, or bone spurs. These can take up space in the carpal tunnel and put more pressure on the median nerve.
- Tumours and other growths . These uncommon causes of carpal tunnel syndrome are usually benign.
- Normal wear and tear of the tissues in the hand and wrist caused by aging.
Treatment For Carpal Tunnel Syndrome
Thankfully, carpal tunnel syndrome is very treatable. It’s important to see a doctor for an exam, to rule out other issues and to learn what you can do to comply with treatments. While a doctor may prescribe pain relievers, administer cortisone shots, or even recommend surgery, there are many complementary steps that you can take to help ease discomfort as you heal. Whether the root cause is rheumatoid arthritis, diabetes, or something else, there’s a lot you can do to help relieve the symptoms of carpal tunnel syndrome.
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Take Frequent Breaks From Repititive Tasks
Daily tasks can be very repetitive and time-consuming, which can be hard on the hands and wrists. When performing such tasks, be sure to stop every fifteen minutes to wriggle your hands and fingers and stretch them out. This will increase blood flow and reduce stiffness which will, in turn, relieve pain.
What If These Treatments Dont Help
In some cases, surgery is needed to make the symptoms go away completely. The surgery involves cutting the ligament that may be pressing on your median nerve. Youll usually get back the normal use of your wrist and hand within a few weeks to a few months after surgery.
Doing the hand, wrist, and finger exercises that your doctor tells you to do after surgery is very important. Without exercise, your wrist may get stiff, and you may lose some use of your hand.
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Modifying Your Hand/wrist Activities
Pressure on the nerve within the carpal tunnel is increased with forceful gripping tasks. It would make sense to take rest breaks and do stretches when you need to use the hands for heavy gripping. For example, when I am in heavy traffic and white knuckle gripping the steering wheel, my hands will go numb. A lighter grip on the wheel will help this calm down. Using vibrating power tools in the yard, such as a hedge trimmer or edger, can also flare up CTS symptoms. Gardening has also been shown in studies to contribute to CTS symptoms. Motorcycle riders often get CTS symptoms because they are forcibly gripping the handlebars and getting hand vibration from the ride. Common sense tells us to be careful with these activities and adjust how the hand is used when possible.
How To Treat Carpal Tunnel Syndrome Without Surgery
Im writing this article for people who want to avoid carpal tunnel surgery. Yes, I am a hand surgeon but Im also a physician, and part of our jobs as physicians is to educate patients about prevention of disease. Hopefully I can teach people about ways to reduce the risk of carpal tunnel syndrome and provide options for treatment prior to requiring surgery. As a disclaimer, patients who have severe carpal tunnel syndrome should be evaluated promptly and not delay treatment unnecessarily. Constant numbness in the hand and loss of muscle mass at the base of the thumb are signs of nerve damage and severe CTS. Surgery is the best way to prevent the nerve from being damaged irreversibly. If people wait too long before having surgery, some of the hand numbness can be permanent. Also, not all hand pain, numbness, and tingling are caused by CTS. If your symptoms are progressive, severe, or not responding to treatment, get an evaluation by a hand specialist or primary care physician sooner rather than later. The recommendations below are intended for patients with mild to moderate CTS symptoms, or in people who want to prevent the symptoms from occurring in the first place. There are some things we cant change about our health, such as our family history, age and anatomy, but there are many things which we can modify.Helpful things to do other than surgery for carpal tunnel syndrome:
Treatments which are NOT helpful for CTS:
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