How to Treat Carpal Tunnel Syndrome

When something causes swelling within the carpal tunnel or tightening of the ligament that goes across it, the nerve becomes pinched and produces numbness, tingling, or pain in the thumb, index, and long finger as well as part of the ring finger.

What Causes Carpal Tunnel Syndrome

The exact cause of carpal tunnel syndrome isn’t known. It can be related to inflammatory processes, chronic diseases such as diabetes or high blood pressure, repetitive activity or handling equipment that vibrates all the time, trauma, and genetic differences.

How is Carpal Tunnel Syndrome Diagnosed?

This condition is diagnosed by physical exam and nerve studies. Ultrasound and MRI are also used, depending upon the circumstances. A patient need not have all of these symptoms to have carpal tunnel syndrome. Sometimes the patient will have one or the other and sometimes it may be nothing more than clumsiness or weakness of the hand. This happens when the motor fibers of the nerve get pinched and it starts to affect the muscle fibers of the hand.

Carpal Tunnel Treatment in Palm Harbor

CTS treatment usually consists of anti-inflammatory medications such as ibuprofen or naproxen sodium as well as splinting and activity modifications. Cortisone injections can help ease the symptoms, but surgery is ultimately the only way to correct the problem in severe cases. There is approximately a 90% success rate with conservative treatment in mild cases.

In surgery, the goal is to cut the transverse carpal ligament, which is the covering of the carpal tunnel. This allows the nerve room to breathe and begin the recovery process. If a patient waits too long, there will be permanent nerve damage.

Nerves will try to heal if given the chance, but they only regenerate at a rate of about 1mm/day in healthy people.

Carpal Tunnel Release Surgical Approaches

If conservative measures don't provide lasting relief, there are other surgical approaches to cut the ligament and treat CTS.

Open release, the old-fashioned approach, involves making a 1- to 2-inch incision in the palm of the hand to sever the ligament. This requires several weeks of recovery time but it is still the most widely used surgical method. This procedure is typically performed in an outpatient surgery center under anesthesia.

Endoscopic release involves inserting a camera beneath the skin through a small incision at the wrist. By looking directly at the ligament, the surgeon can watch as the blade makes the cut. This approach has a faster healing time than open release but it still takes about 2 weeks before the stitches come out. This procedure is done in an outpatient surgery center under anesthesia.

Ultrasound-guided release involves using an ultrasound probe to visualize the nerve and the entire contents of the carpal tunnel while the surgeon uses a small knife to cut the ligament. The incision is even smaller than that used in an endoscopic release. It requires no stitches and has an average return to function of about 2-3 days. Ultrasound-guided carpal tunnel release can be done in the doctor’s office under a local anesthetic, thereby avoiding anesthesia as well as any charges associated with anesthesia and the surgery center. Orthopedic Specialists is among the few practices in the Tampa Bay area to offer this procedure. 

All three methods perform the same function: to cut the transverse carpal ligament and give the nerve the room that it needs to decompress and try to heal. The results of the different procedures show no significant differences, and each way is very safe to perform. There is roughly a complication rate of 2 per 1,000 cases in carpal tunnel surgery. 

For proper diagnosis and treatment of your carpal tunnel dysfunction, schedule an evaluation with our Palm Harbor orthopedic hand and wrist doctor by calling 727-496-2391.