Carpel Tunnel Basics
Carpel tunnel syndrome (CTS) is a common condition that occurs when the medium nerve, which runs through the carpel tunnel in the wrist, becomes compressed. Compression of the median nerve leads to a range of symptoms, including numbness, tingling, weakness, and pain in the hand, fingers, and wrist. The prevalence of CTS in the general population is between 1%-5%, with a female-to-male ratio of 3 to 1. Severe cases can lead to difficulty holding objects, buttoning clothing, or turning a doorknob. Bilateral symptoms are common and typically worse in the dominant hand. Repetitive movements of the wrist can contribute to CTS, including working on a keyboard or computer mouse, using mechanical tools like a ratchet and hand-held vibrating tools.
How is CTS diagnosed?
A physical exam is the main diagnostic tool used to diagnose CTS and if 3 or more of the following signs or symptoms is a common classification system utilized and include paresthesia or numbness along the median nerve distribution, nocturnal paresthesia, thenar atrophy, positive Tinel test, positive Phalen test, and decreased sensitivity. The Tinel test is positive when a healthcare provider taps the wrist, triggering a tingling or numbness sensation. The Phalen test is performed when a patient places both elbows on a table and touches the back of the hands together, holding the wrist in maximal flexion for 30-60 seconds. A positive test is elicited when tingling or numbness is reported. Other potential diagnostic tools include nerve conduction studies, which evaluate the electrical impulse velocity, and electromyography (EMG), which measures muscle response to nerve stimulation.
What treatment options are there?
Treatment depends mainly on the severity of symptoms. Often, conservative home remedies can do the trick. Rest, ice, gentle stretching, and over-the-counter anti-inflammatories can frequently relieve symptoms. Wearing a wrist splint can also rest the nerve and relieve pressure, especially at night. Physical or occupational therapy might also provide another layer of treatment using a combination of ultrasound, stretching, and range-of-motion exercises. Some healthcare providers may prescribe oral or injectable corticosteroids as a temporary measure for moderate cases. Severe or refractory cases will often be referred for surgical evaluation and median nerve decompression. Many surgical techniques are available, but minimally invasive keyhole surgery has many proven benefits.
1. Only local anesthetic is necessary
Many minor surgeries require extensive anesthesia, including regional nerve blocks or procedural sedation. This advanced procedure is performed with lidocaine injected through a small needle along the incision site. This minimizes potential complications from further anesthesia and procedural time. In addition, the procedure can be scheduled in an outpatient ambulatory surgical center, avoiding delays in going to the hospital and returning home the same day.
2. Incision size is minimal
The surgical procedure is considered microsurgery and requires a 1.5cm incision across the wrist to expose the anatomy. Smaller incisions amount to fewer complications, less pain, and faster recovery times. Cosmetic results are an added benefit with less scarring.
3. Quicker return to work
Minimally invasive keyhole surgery reduces prolonged downtown following many open surgeries. Physical therapy can be started sooner, improving healing and overall hand function curtailing time away from work. Patients can return to everyday activities more quickly and reduce the impact of the procedure on daily life.
4. Better outcomes
Keyhole surgery for CTS is fast, safe, and effective. In one study, substantial symptom relief was reported in 90% of participants immediately following surgery. Another 7% noted symptom improvement within the first month postoperatively. 97% of participants reported significant functional symptom improvement at one-year evaluation.
A minimally invasive solution for carpel tunnel
Keyhole surgery offers several advantages for individuals suffering from carpel tunnel syndrome. This minimally invasive procedure effectively addresses the underlying cause of pain, resulting in reduced discomfort, faster recovery times, minimal scarring, and overall improved hand function long-term. Consulting with an orthopedic surgeon can help determine if keyhole surgery is the right treatment option.
