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Carpal tunnel syndrome is a painful, uncomfortable, yet common condition. It occurs when the median nerve that connects to the hand is compressed in the carpal tunnel of the wrist. This causes pain, numbness, tingling, and weakness in the hand and forearm.
The carpal tunnel is the narrow opening in the wrist. The median nerve travels down the arm, through the carpal tunnel, and into the hand, where it is responsible for sensation and movement in the hand, thumb, and fingers. Tendons that control movement in the hand also travel through the carpal tunnel.
Narrowing in the carpal tunnel puts pressure on the median nerve causing carpal tunnel syndrome and its symptoms. There can be several underlying causes or risk factors, but repetitive movement in the hand and wrist are common factors.
Treatment typically begins with non-surgical strategies and only progresses to surgery if these do not provide relief:
When non-surgical treatments fail to provide adequate symptom relief, doctors suggest carpal tunnel release surgery. This can be done as a traditional open procedure or a minimally-invasive endoscopic surgery. In both procedures, the surgeon splits the transverse carpal ligament to make more room in the carpal tunnel.
Steroid injections in the wrist reduce inflammation, opening up the carpal tunnel and relieving pressure on the median nerve. One of the downsides of this treatment is that it is temporary. Potential side effects include immediate pain in the wrist and a risk of infection. Serious complications are unlikely, but a poorly performed injection can cause nerve damage.
For patients with mild symptoms and diagnosed with the syndrome early, a steroid injection might provide greater long-term relief. For those with a lot of damage and more severe symptoms, the injection usually only provides temporary relief.
Even if surgery is eventually needed, steroid injections can delay it. According to a study of over 100 patients, those receiving injections were less likely to need surgical interventions over the following five years.
Chiropractors treat carpal tunnel syndrome, and surgeons often recommend physical therapy as an option before trying surgery. Stretches and exercises can help the median nerve better through the wrist. A chiropractor looks at the spine and makes adjustments that might affect the carpal tunnel and median nerve.
The risks of physical therapy or chiropractic care are low, so many patients prefer to try these non-medical interventions first. They are unlikely to provide lasting relief, however, and many patients ultimately need medications, injections, or surgery.
Your specialist can talk to you about surgery and help you decide if it’s the right choice. Every patient is different, and surgeons consider symptom severity, diagnostic findings, and your response to non-surgical care before recommending surgery. In general, you might need surgery if other options no longer bring you relief.
Orthopedic hand and wrist surgeons have two main options for surgically treating carpal tunnel syndrome: open and endoscopic. Open surgery requires an incision in the palm of the hand. For an endoscopic procedure, the surgeon makes smaller incisions and inserts a scope to view the inside of the wrist and hand and perform the release.
Both types of surgery provide relief and have similar risks. Recovery times are a little shorter with endoscopic surgery.
Your surgeon will prepare you for the procedure by explaining what will happen and what you need to do to be ready. You might only need a local or regional anesthetic for the procedure, but your surgeon will discuss these options with you. It is an outpatient procedure for most patients.
Recovery from carpal tunnel surgery requires some rest. Expect some pain and swelling and to have to rest the wrist and hand. Recovery times vary depending on the patient, but you might need to wait up to six weeks before you can do anything strenuous with that arm. Full recovery could take several months to a year.
Cost is a valid concern when considering surgery versus other treatment options. Carpal tunnel syndrome is painful and debilitating, so most insurance plans cover treatment, including surgery. Talk to your specialist and your insurance company about costs, so you know what to expect and can make the best treatment choice to meet your needs.
Carpal tunnel syndrome is painful and can take a toll on your normal activities, but treatments work. Request an appointment to talk to one of our hand and wrist specialists when you’re ready to talk about treatment options.