What is Carpal Tunnel Syndrome?
The Carpal Tunnel is a narrow, tunnel like structure at the base of the hand. The bottom of the tunnel is made up of the wrist bones, and the top of the tunnel is covered by the transverse carpal ligament. The tunnel houses nine tendons and the median nerve as they run from the forearm to the hand. The median nerve is an extremely important nerve that controls sensation to the palm side of the hand and supports movement of the fingers and thumb. Sometimes, due to injury, repetitive motion or disease, the tendons within the carpal tunnel can become inflamed and swell. This swelling will then place pressure on the median nerve and cause the symptoms of carpal tunnel syndrome.
Symptoms of Carpal Tunnel Syndrome
Symptoms are often first noticed at night, and relief may come from shaking the hand. Most often symptoms appear in the thumb, index finger, middle finger, and ring finger. Symptoms appearing in these fingers but not in the little finger may be a sign of carpal tunnel, as a different nerve runs to the little finger. Symptoms include:
- Tingling, numbness, weakness, or pain in the fingers or hand.
- Pain in the arm between the hand and elbow, or sensations traveling up the arm towards the shoulder.
- Decreased grip strength.
If caught early non-surgical treatment may be sufficient. This can include bracing, medications, exercise and physical therapy. If these options fail, surgery is generally recommended. Carpal Tunnel surgery is one of the most common surgical procedures. During the procedure the transverse carpal ligament is cut, which creates more space in the carpal tunnel, relieving pressure on the median nerve.
Traditional Carpal Tunnel Surgery Options:
Open Carpal Tunnel Release (OCTR)
For an OCTR, the surgeon will make up to a two inch incision in the wrist and palm to expose the transverse carpal ligament. After retracting the surrounding tissue, the surgeon will then cut the ligament to open up more space within the carpal tunnel, thereby relieving pressure on the median nerve. The incision will then be closed with stitches, and the hand will be wrapped and braced. The wound will most likely leave a scar, and pain may be felt at the incision site for up to six months. Postoperative care normally includes office visits for wound care and removal of stitches, pain medication, bracing, and physical therapy. Patient recovery time before returning to work can be as long as thirty-eight days.
Endoscopic Carpal Tunnel Release (ECTR)
The goal of an ECTR is to reduce the incision size to allow for faster recovery and decrease pain after surgery. One or two half-inch incisions are made in the wrist and palm to allow a camera, an endoscope, to be placed within the carpal tunnel. Normally, a dialator will then be inserted into the incision(s) to create enough as compared to an OCTR. Postoperative care is similar to OCTR, but varies based on the endoscopic system used. space to fit the endoscope and other instruments into the carpal tunnel. Once the surgeon has visualized the transverse carpal ligament, a blade will be inserted to cut the ligament. Stitches are generally used to close the incision(s), but scarring is reduced.
MANOS™ Carpal Tunnel Release System
The latest advancement in carpal tunnel release technology, the MANOS™ Carpal Tunnel Release System gives patients the option to release the transverse carpal ligament (TCL) through surgical access measuring as little as 2mm ( actual size). Through this access to the carpal tunnel, the surgeon releases the TCL with the MANOS™ cutting surface. The MANOS™ cutting surface is exposed only after the surgeon first safely positions the device in the carpal tunnel. While positioning the device, MANOS™ is completely blunt and compatible with nerve stimulation guidance and ultrasound guidance. The entire procedure is performed in about ten minutes. After the procedure, two small band-aids are used to cover the surgical access points. MANOS™ is designed to minimize surgical trauma and reduce patient recovery time. Because surgical access is so small, stitches are not normally required and scarring is minimized or eliminated. MANOS™ patients typically recover quickly, with some patients returning to work as early as the same week of surgery. Postoperative care is limited and generally does not include splinting or physical therapy.