Carpal Tunnel Release

What is carpal tunnel release surgery?

Carpal tunnel syndrome occurs due to excess pressure exerted on the median nerve. Your median nerve runs along your arm and passes through your wrist (via the carpal tunnel) before ending in your hand. 

The median nerve plays a significant role in controlling the feeling and movement of your thumb. It also helps move your fingers freely except for your small finger (also known as a pinkie). Read on to understand the anatomy of your carpal tunnel, what causes carpal tunnel syndrome, its symptoms, diagnosis, treatment options, and prevention. 

Carpal Tunnel Release Anatomy

Your carpal tunnel is that narrow passageway located inside your wrist. This particular structure is about one inch wide. The sides and floor of your carpal tunnel are made of small wrist bones, commonly known as carpal bones. On the other hand, the roof of your carpal tunnel comprises the transverse carpal ligament or a band of connective tissue. 

As one of the main nerves within your hand, the median nerve stretches from the neck and other nerve roots. These nerve roots fuse to form one major nerve in your arm. The nerve allows your hand to have a sense of touch and feel. It also controls a set of muscles found at the base of your thumb. Up to nine tendons pass through your carpal tunnel, and they are collectively referred to as flexor tendons.

What Causes Carpal Tunnel Syndrome?

A combination of factors is responsible for causing carpal tunnel syndrome. As a matter of fact, more women and older people are at risk of developing carpal tunnel syndrome than men. So, your age could be a major factor that may contribute to the development of this condition. Other factors that can cause carpal tunnel syndrome are as follows:

• Heredity is one of the top factors likely to cause carpal tunnel syndrome. The condition may become smaller in some individuals than in others. Also, there is an anatomical difference that determines the space for the median nerve. These traits are believed to run in families, making heredity a major risk factor for this condition.
• Repetitive hand use is yet another factor that leads to the development of carpal tunnel syndrome. Making repetitive hand movements and several wrist motions for long periods may aggravate flexor tendons in your wrist.
• The position of your hand and wrist can cause carpal tunnel syndrome. This happens more often when performing activities that require extreme extension or flexion of your hand and wrist over a prolonged period. 
• In women, pregnancy may cause carpal tunnel problems. This is attributed to the changes in hormones during the pregnancy period. These hormonal changes can cause swelling around the wrist.
• Health conditions such as rheumatoid arthritis, diabetes, and thyroid gland imbalance are associated with the development of carpal tunnel syndrome in many people.

Symptoms of Carpal Tunnel Syndrome

Common symptoms of carpal tunnel syndrome include:

• Burning, numbness, tingling, and pain in your index, middle, ring fingers, and thumb.
• On some occasions, you may feel shock-like sensations radiating to your thumb and fingers, except the small finger. 
• Sometimes you may feel tingling or pain that travel up your forearm and toward the shoulder
• You may feel clumsiness and general weakness in your hand. These feelings can negatively impact how you perform fine movements like buttoning your clothes or fastening your shoelaces.
• Lack of grip in your fingers and thumb is another symptom to look out for. This symptom may cause you to drop things because of numbness, weakness, or complete loss of awareness of your hand is in space (also referred to as proprioception)
• Numbness in the hand, that can be so severe it awakens you when you sleep.

Symptoms associated with carpal tunnel conditions often start gradually even without experiencing any injuries or damage to your wrist and hand. Your symptoms may appear and disappear without treatment. When these symptoms get worse, you may experience them more frequently for a long time. 

There are also nighttime carpal tunnel symptoms. Nighttime symptoms can occur when you sleep with your wrist bent. These symptoms may also awaken you from sleep. During the daytime, these symptoms occur when you are holding an object for a relatively long time with your wrist bent backward or forward. This is common, especially when driving, reading a book, or using a phone. Some patients find that shaking or moving their hands helps with their carpal tunnel pain relief.

Why might I need Carpal Tunnel Surgery?

The main reason you may need to undergo carpal tunnel release is if the symptoms worsen or become constant or painful or chronic for more than 6 months.   The doctor will suggest that you try non-surgical treatment options before considering the surgical treatment procedure. Additional reasons for carpal tunnel release surgery are:

• When the non-surgical treatment options for your carpal tunnel problem don’t work for you.
• After your healthcare provider performs diagnostic tests such as electromagnetic tests, X-rays, and CT scans of your median nerve to determine if you are suffering from carpal tunnel syndrome.
• If the muscles in your hands and wrists are weak or becoming smaller due to severe pinching and pressure on the median nerve.
• If symptoms associated with carpal tunnel syndrome last six or more months without relief

Carpal Tunnel Release Diagnosis

Your healthcare provider will perform different tests to rule out other health conditions that may be affecting your hand and wrist. The doctor will start by evaluating your medical history before performing diagnostic tests using these techniques:

1. X-rays. This type of carpal tunnel test provides detailed images of dense structures in varying shades of white and black. The X-ray may exclude cases like ligament injury, fracture, or arthritis.
2. MRI: MRI scans provide images of your body’s soft tissues. The doctor may suggest an MRI to determine other conditions with similar symptoms to carpal tunnel syndrome.
3. EMG: Electromyogram or EMG will show whether there is muscle or nerve damage in your wrist and hand by measuring electrical activity in your muscles.
   

How to Treat Carpal Tunnel Release? 

After a successful diagnosis of your carpal tunnel problem, the doctor may take these two approaches in treating your condition:

1. Non-surgical Treatment

With the non-surgical form of treatment, your caregiver may encourage you to use bracing or splinting during the night to prevent you from bending your hand or wrist. The doctor may further prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) or suggest activity change, nerve gliding exercising, carpal tunnel relief exercises, or the use of corticosteroids or cortisone (steroid injections).

2. Injection

In some cases, an injection of cortisone into the carpal tunnel around the nerve, typically done under ultrasound guidance, can be performed to assist in temporary relief of symptoms.  Also, injections into the carpal tunnel are performed to make a more accurate diagnosis if the symptoms or exam or diagnostic tests are inconclusive.  

3. Surgical Treatment

Carpal tunnel surgery may come in handy if non-surgical treatment options fail to relieve your symptoms. Therefore, your surgeon will perform surgical procedures such as open carpal tunnel release and endoscopic carpal tunnel release depending on the severity of your condition.

Prevention of Carpal Tunnel Release

To date, there is no proven strategy to control or prevent carpal tunnel syndrome. Regardless of that, you may minimize stress on your wrists and hands using these helpful methods:

• Always relax your grip and reduce your force when handling different objects
• Make sure to take short but frequent breaks between your working hours to stretch or bend your hands and wrists periodically. 
• Watch your form by avoiding bending your wrists all the way upward or downward.
• Keep the right posture because incorrect posture may roll your shoulders forward, compress nerves in the neck, and shorten the shoulder and neck muscles. All these may negatively affect your fingers, hands, and wrists, not to mention causing neck pain.
• Use a comfortable computer mouse that doesn’t strain your hand and wrist. If possible, replace your computer mouse with a better one.
• Keep your hands warm to avoid stiffness and hand pain while working in a cold environment. 

At Sforzo I Dillingham I Stewart Orthopedic + Sports Medicine, we are committed to providing world-class medical care to patients with carpal tunnel syndrome. Dr. Christopher R. Sforzo, and  Dr. Christopher L. Dillingham, will help you by diagnosing and providing expert treatment for your carpal tunnel problem. 

Our doctors are board-certified orthopedic surgeons and fellowship-trained in various types of surgeries that involve the arm, elbow, shoulder, forearm, hand, and wrist. They use minimally invasive surgical techniques, including endoscopic carpal tunnel release, arthroscopic elbow and wrist procedures, joint replacement, arthritis surgery, and reconstruction of spinal deformities, among others. 

Final Thought

Carpal tunnel syndrome (nerve compression) is a medical term that describes one of the most common health problems affecting hands. Patients with carpal tunnel syndrome are likely to feel numbness, pain, tingling, and general weakness in their wrists and hands. Contact Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine to learn more about carpal tunnel syndrome and its treatment.