Carpal tunnel syndrome (CTS) is an interesting medical issue because it is treated by so many specialists – orthopedic surgeons, hand surgeons, plastic surgeons, and general surgeons. Given that the injury is related to a particular nerve (which we’ll discuss momentarily), you may want to consider having a peripheral nerve surgeon perform the procedure for you.
The reason for this is because peripheral nerve specialists are trained and experienced in relieving neuropathic pain for our patients. When a nerve needs to be decompressed, our approach and choice of technique are going to be very thorough in ensuring the affected nerve is freed from compression.
As you are likely aware, CTS is a problem affecting the wrist and hand. This upper extremity injury develops when your median nerve is compressed within the carpal tunnel – a narrow anatomical passageway located on the palm side of the wrist and formed by bones and ligaments in the area.
The condition often, but not always, occurs as a result of repetitive motions like typing, writing, and activities that may be used in various occupations. It can cause symptoms like frequent tingling and burning sensations, decreased grip strength, numbness, and muscle atrophy at the base of the thumb (in severe cases). When the condition progresses in severity, these symptoms can lead to disrupted sleep – waking you up at night with intense pain.
Is the common conception that CTS is always caused by repetitive stress accurate? Well, not always. There are many cases wherein the injury is the result of repetitive stress, but sometimes they have other root causes – like obstructed blood flow or underlying medical conditions that lead to swelling in the wrist.
This condition can often be recognized based on physical examination, symptoms, and medical history. With that said, an EMG (electromyograph) can provide neurophysiological evidence that the median nerve is pinched (which causes the problem).
It is critical to treat carpal tunnel syndrome before the condition worsens. If the symptoms are ignored, they may cause long-term damage.
There are conservative treatment options, but surgery may be the best option to restore function and alleviate pain when physical therapy, splinting, and other nonsurgical treatments are ineffective.
Carpal tunnel syndrome can be treated with surgery to decompress the median nerve by cutting the ligament at the bottom of the wrist to release pressure. The carpal tunnel is right above the wrist on the palm side of the hand. We will make a small incision and then cut that ligament to free the nerve.
Depending on the severity of your carpal tunnel, your symptoms, your overall health, and the anatomy of your hand, we may decide to perform the surgery in one of two general ways:
- Surgery may be performed using an endoscope and a small incision.
- Surgery can also be performed using a standard surgical incision and decompression of the nerve.
Either way, this is an outpatient procedure and you go home the same day. Your hand and wrist may be bandaged for up to 10 days. Typically, the bandage stays in place until the stiches are removed.
You may or may not experience immediate relief, as the area will be sore following surgery. That initial soreness will improve over time. It is recommended that you rest and elevate your hand and wrist, as well as limiting their use. It's not necessarily that the surgery is a big deal in and of itself, but you likely use your hands a lot, so that may limit your ability to work. Depending on what you do for work, you may need some time off.
For more information about carpal tunnel treatment—or if you want to find relief from neuropathic pain caused by injured peripheral nerves—contact our Baltimore office by calling (410) 709-3868 or connect with us online today.