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Carpal Tunnel Syndrome

Why Does it Occur?

Carpal Tunnel Syndrome is perhaps the most common disorder of the hand, and seems to be increasing in incidence.  Contrary to popular belief, Carpal Tunnel Syndrome is not necessarily caused by computers. In general, it is caused by anything that causes compression, swelling, or decreased space in the carpal tunnel.  This can include bending the wrist for extended periods, external pressure on the wrist such as when doing push-ups or riding a bike, or overuse activities for which excessive computer use may have a causative role.  Having the diagnosis of Carpal Tunnel Syndrome puts you at increased risk for having other overuse related disorders such as Trigger Finger, DeQuervain's Disease, or Carpal Tunnel Syndrome in the opposite hand.

 

Symptoms

Patients most commonly experience numbness, tingling, and pain in the distribution of the median nerve (thumb, index, middle, and half of the ring finger on the palm side).  Symptoms will vary based on the severity and how long the nerve has been compressed. When the nerve is either severely or chronically compressed, weakness of the thumb can occur.

 

Diagnostic Testing

An Electromyogram (EMG) may be ordered to further evaluate your nerve compression and rule out other potential causes for your symptoms such as neck pathology.

 

Treatment Options

You may be advised to wear a splint to help keep the wrist in neutral position.  Prolonged flexion or extension of the wrist and leaning on the palm side of the wrist can cause nerve compression.  These positions are therefore discouraged.  A thoughtful look at your work-space ergonomics can be helpful, especially ensuring your wrist is in a neutral position while using a keyboard.  There are injection options such as cortisone that may also be considered.  If the nerve compression is severe and causing weakness, surgery may be advised.

 

Surgical Treatment

Surgery may be recommended if you have not improved with non-operative treatment, or if the nerve becomes severely compressed enough to cause weakness in the thumb.  There are two main surgical techniques to surgically correct this disorder:  Traditional Open Carpal Tunnel Release and Endoscopic Carpal Tunnel Release.  Research comparing the two techniques have definitively shown that patients who have had Endoscopic Carpal Tunnel Release return to their normal function faster (including work and sports), usually an average of 2-4 weeks faster that Open Carpal Tunnel Release.  Many patients are also happier with the cosmetic benefit of a smaller incision.  The average time to perform the surgery is about 5 minutes and entails opening up the carpal tunnel in order to create more space and to take pressure off of the nerve.  

 

Dr. Steven Lee is one of the few hand surgeons in NYC that performs Endoscopic Carpal Tunnel Release surgery.  He has arguably done more Endoscopic Carpal Tunnel Releases than anyone else in the NYC, and regularly instructs hand surgeons from around the world on how to do it safely.  Learn more about the procedure here.

 

Surgery for Carpal Tunnel Syndrome leads to successful results in greater than 95% of patients who have the surgery performed in a timely manner. It is important to know that results of the surgery depend upon a number of factors.  The most important factors are how long and how severely compressed the median nerve is before surgery is performed.  Because Carpal Tunnel Syndrome often does not produce super disabling symptoms until late in the progression of the disease, patients often put off having the surgery performed until it is too late.  Like a rock that is squashing a garden hose, the longer the rock is pressing on the nerve, the more likely the hose can be permanently deformed after removing the rock.  Similarly, carpal tunnel surgery aims to merely take the pressure off of the nerve; therefore, if the nerve has been compressed too severely or too long, the nerve may be permanently deformed despite trying to take the pressure off of it through surgery.  Other factors affecting the surgery's success rates include Diabetes, smoking, other neurologic disorders, and the body's inherent ability to heal and produce scar tissue.  

Learn more about scheduling surgery.

 

Post-Operative Care

After surgery, a soft dressing will be placed on your hand that must be kept clean and dry.  Patients can move their fingers right away.  After a week, the dressing is removed in the office, and we will most likely remove your sutures at that time.  You may have some sensitivity at the incision site after surgery for up to 4 weeks, especially with gripping or activities such as push-ups. Hand/physical therapy can help decrease scar tissue and hypersensitivity, as well as improve range of motion.  After 4 weeks, patients often return to their normal activities.

 

Learn more about post-operative care.

 

Post-Operative Instructions

Download here.

 

*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables.  It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.