Carpal Tunnel Syndrome Treatment

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Hand and upper extremity surgeon Dr. Mark McBride describes carpal tunnel syndrome and available treatment options.

Dr. McBride: Well, I'm Dr. Mark McBride. I'm a hand surgeon. I'm a member of the Tri- County Orthopedic Surgical Group.

Carpal tunnel syndrome is a syndrome where a nerve gets compressed in the palm of the hand. If you look at the model of the hand, the tendons under the hand on the palm side enter into an area we call the carpal canal. As the nine tendons that make the digits move enter into the area, there's a tight band of ligament that holds them into position. What happens is that gets compressed, the area does not get enough room, and there's a nerve that accompanies the tendons. As it accompanies the tendons, the tendons swell, the nerve gets compressed, and you lose feeling in the outer parts of your hand and your fingertips. Also, it weakens the muscle in the thumb, so you get a combination of symptoms of numbness, these are transient, some weakness of the hand, which can sometimes be accompanied with pain, or sometimes it's just a rather annoying numb feeling in the hand.

The causes of carpal tunnel syndrome have been debated over the years, but what's really is shown in the past several years of research is that the carpal tunnel is just an anatomic zone in the hand. That's where the tendons go through. The majority of people realize now that the causes are not what all these people thought, like typing. It's basic causes are just genetic predisposition. People have a predisposition for the hand and tendons to swell. And if they do a lot of activity, which can sometimes aggravate the tendons, they have a higher predisposition to develop the symptomatology of carpal tunnel.

Once people have carpal tunnel syndrome, the initial attempt will be to be conservative. Conservative just means basically nonoperative. Probably the most important aspect of that is going to be basically rest. The less you use your carpal tunnel or the tendons, you'll tend to have less irritation to them. They'll swell less and they can calm down. Also keeping the wrist straight, which is the reason why we tend to use wrist splints a lot.

If people fail the conservative treatment methods for carpal tunnel, then surgery will probably become necessary. Surgery is actually very simple in concept. If you look at the model, the carpal tunnel is just an area and it's a small, basically, tunnel. So what we have to do is open that tunnel up, which sort of involves opening up the ligament that's here. Nowadays, we have microscopic techniques where we can make mini-incisions of about a centimeter, four approximal to the wrist is by that and find that ligament. That releases it and leaves more room for the nerve to function.

The advantages of doing a mini or a micro approach to carpal tunnel release has significantly reduced the complications and the time to recovery for carpal tunnel. It's reduced almost 90%, getting people back to activities and work much, much quicker than we were able to in the past.

Following carpal tunnel surgery using the microscopic approach, we find most people the following day are able to drive. They can shower and bathe within two days. Return to work if it's a desk-type job usually in two or three days. And get back to the gym and things they want to do in a very short period, normally, as I said, one to three days is normal, and go about their normal activities definitely within that period.

Once people have undergone the mini approach carpal tunnel surgery, they go home the same day, so it's about a two-hour stay in the hospital. They're not allowed to drive or use any equipment that day because they have been under sedation. But by the following day, we expect them to be up and about for business. Driving is okay; they can usually shower after 36 hours and increase the level of activity as they feel comfortable. But things like going to the gym and driving definitely are basically doable the following day. And they want to get back to their normal level of activity normally within, I would say, 48 hours.

I believe the strongest point you really want people to understand when it comes to carpal tunnel is that you want to have the approach where you're realizing you're getting back to your normal level of activity much sooner than people in the past. You always hear people say, oh, I had my friend, never got back to playing sports again. Those days, I think, really are over. We can make the approaches, we can find we can get people back to their normal activities the following day with absolutely no limitations except for keeping it dry for about 36 hours. Whereas going to the gym, driving, working, all can be done within a 48-hour period with no harm basically to that wrist. Once surgery's completed, you really cannot do any damage to the hand. All we have to do is let the wound heal, and people can go about their business as soon as possible.