Carpal tunnel syndrome is a disorder where the median nerve and tendons that run through a structure in the wrist called the carpal tunnel are impinged, or squeezed. This nerve and the tendons serve the thumb and the first three fingers of the hand, so the symptoms are mostly felt there. The dominant hand is most often affected, and women are far more likely to be affected than men. Symptoms, which start slowly and build, include numbness and tingling and burning sensations and sharp shooting pains that start in the wrist and go up the arm, especially at night. The hand is often stiff in the morning, and the thumb is weak to the point where it’s hard to make a fist.
People who suffer from carpal tunnel syndrome sometimes wonder if they should have it surgically treated. There are more conservative treatments for the disorder, and in some people it goes away by itself. For people who aren’t sure, here are three signs that carpal tunnel surgery may be needed:
1. The patient has acute carpal tunnel syndrome.
This is a very rare condition where the nerve is compressed because the patient’s wrist has been fractured or dislocated, or they have some type of vascular problem that might cause bleeding in the area. The bleeding cuts off the flow of oxygen and nutrients to the tendons and nerves and causes them to deteriorate. Even more unusual are cases where acute carpal tunnel syndrome comes about because of spontaneous bleeds in the person’s wrist. Doctors don’t know why this happens, but surgery needs to be performed quickly in cases of acute carpal tunnel syndrome.
2. The pain and weakness of the disorder interferes with the patient’s day-to-day life.
Since the symptoms of a carpal tunnel syndrome begin gradually, some patients feel that they can simply tough them out and hope that they’ll go away on their own, which sometimes happens. Some patients endure their symptoms for years before they seek relief even as the symptoms persist or grow even more severe. The burning and shooting pains may wake the person up at night, and some patients who wait a long time before they have their carpal tunnel syndrome seen to find that their thumb and the muscles at the base of their hand are so weak that they can’t pick up or hold objects the way they used to.
3. Other, more conservative treatments don’t ease the patient’s symptoms.
A patient who goes to their doctor for treatment may get a corticosteroid injection to ease the pain and swelling and improve their mobility. The doctor may also put their wrist in a splint and recommend a physical therapist who can use massage to ease the symptoms and suggest gentle exercises such as wrist flexor stretches. If none of this eases the patient’s pain, then their doctor might recommend surgery.
Carpal Tunnel Surgery
The patient has a choice of open surgery or endoscopic surgery. Endoscopic surgery is becoming more and more popular since it does not require a large incision or that the patient be placed under anesthesia. Both surgeries cut through the carpal tunnel ligament or the flexor retinaculum. This releases the compressed nerve and cures the patient’s symptoms.
In endoscopic surgery, the surgeon makes small incisions in the palm of the hand and the wrist or one small incision in the wrist. They then insert a tiny camera that’s connected to a monitor. This guides the surgeon as they find the flexor retinaculum and cut it. The incision or incisions are then just covered with bandages, though in the case of an open surgery the wound is sutured. The sutures are taken out after about 10 days or are absorbed by the body.
Both types of surgeries are outpatient procedures where the patient can go home soon after the surgery. Both are effective in resolving carpal tunnel syndrome, though the patient with an endoscopic surgery has a faster recovery time. Most patients who have any type of carpal tunnel surgery make a complete recovery.
