Carpal tunnel syndrome impacts 4 million to 10 million Americans, according to the Rheumatology Research Foundation. But if there’s good news for those who suffer from this common nerve disorder, it’s that minimally invasive treatment options are available and can eliminate discomfort and restore range of motion quickly and safely.
What Causes Carpal Tunnel?
When the median nerve, which passes through the carpal tunnel on the inner wrist, is compressed, numbness, tingling and pain may occur in the fingers and hand.
“The main symptom is numbness, particularly in the distribution that this nerve serves, which is the thumb through the middle finger and a little bit of the ring finger, although patients often experience this numbness throughout their whole hand,” said Dr. Alexander Marcus, hand and wrist orthopedic surgeon at Hackensack Meridian Health – JFK University Medical Center. “Patients often experience pain with it as well in the hand, and even sometimes radiating from the wrist up toward the elbow.”
Dr. Marcus said patients who suffer from carpal tunnel syndrome frequently wake up in the middle of the night bothered by numbness in the hands. For some, it may be temporary. For others, it may linger, making it difficult to complete routine activities such as buttoning a shirt, clasping earrings or necklaces, or even brushing teeth due to lack of feeling or sensation in the hands and fingers.
“Nerves also give muscle function and strength and so you can develop weakness and even atrophy in the hand,” he added.
If left untreated, carpal tunnel syndrome can cause permanent damage, making it imperative that those with symptoms seek treatment before the condition worsens.
Getting A Proper Diagnosis
Not everyone with pain or a funny feeling in their wrist has carpal tunnel, Dr. Marcus explained.
“You have to have a doctor confirm that this is the problem — that it’s not a more generalized problem such as a neck issue or something like that,” he said. “A lot of patients who have wrist pain have tendonitis. Those patients, in my experience, do well with correcting ergonomics and with therapy. So, it’s really important to have someone who knows make the right diagnosis.”
Dr. Eric Strauss, chief of hand surgery at Virtua Health, explained that the gold standard for diagnosis is nerve testing, which is predominantly done in a doctor’s office. This quick procedure ensures that the patient is being treated for the right condition.
“It’s not a completely pain-free examination because you get a little shock and twitch to your nerve,” Dr. Strauss said. “But especially with carpal tunnel syndrome, you only need to do a very targeted look at one or two nerves briefly.”
Dr. Strauss added that having nerve testing done at a hand center makes for a targeted, quicker test with less discomfort.
Treatment Options
Once a carpal tunnel diagnosis has been confirmed, patients face two surgical options.
“One, which has been done for many years, involves making an incision in the palm of about 3 or 4 inches depending upon doctor and patients, and through that incision, going through the skin and down to the carpal tunnel and making an incision in that,” Dr. Strauss said. “The other option is the newer way, which is endoscopic. The endoscopic approach is to use a video camera to provide visualization of what we’re operating upon. Because we use a video camera, we make a very tiny incision.”
Rather than making a 3- to 4-inch incision in the palm, the endoscopic approach allows surgeons to make a half-inch incision closer to where the wrist meets the forearm, Dr. Strauss added.
“Instead of going through the skin and all the soft tissues and putting a big incision in the palm, we can avoid the palm entirely, which is where we grip, so that is good, and the incision is tiny. Instead of maybe six or eight stitches in the palm, there’s one or two stitches in the end of the forearm,” Dr. Strauss said.
Dr. Strauss explained that by using the endoscopic approach, the average surgery is complete in four minutes. Recovery time also is brief. Patients can use their hands the day of surgery and can drive the next day. There’s usually no splinting or casting involved.
“Procedures are done under a local with a little sedation in most cases,” he said. “There’s no general anesthesia for either surgery.”
Dr. Marcus agreed and said that the myth he often hears is, “Well, I’ll be out of work for six weeks.”
“That’s rubbish,” he said. “I have patients who go back to work a day or two later with either open (traditional) or endoscopic carpal tunnel release.”