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Monday, July 19, 2010

Carpal Tunnel Syndrome, Part 2

Post provided by Robert Foster, MD

In the last post we discussed how CTS is diagnosed and nonsurgical treatment. Part two discusses the surgical treatment for carpal tunnel syndrome.

Surgical carpal tunnel release remains the standard of care for severe carpal tunnel syndrome or when conservative treatment modalities have failed. Unfortunately, there still seems to be a great deal of fear and misinformation surrounding carpal tunnel surgery. Today carpal tunnel surgery can be performed with local anesthesia, with the patient wide awake, eliminating the need for fasting or an I.V. Many patients who have local anesthesia will come to surgery alone and drive themselves to and from the surgery center. For those patients who are still anxious about being alert during surgery, oral and I.V. sedation can still be made available.

Mini-incision carpal tunnel surgery is performed with the patient lying flat on their back with a small tourniquet on their forearm to prevent bleeding during surgery. A small half inch incision is made at the base of the palm and through this incision the transverse carpal tunnel ligament is divided in half, essentially opening the roof of the carpal tunnel and removing the pressure on the median nerve. Once the ligament is divided, the incision is closed with only one or two stitches. The entire procedure usually takes only 10 to 15 minutes. Following surgery, a light, soft dressing is applied, with no splint, and is worn for four to five days. Once the dressing is removed, a simple band-aid can be used to cover the incision to protect the stitches. After surgery patients are encouraged to move their wrist and fingers frequently and use their hand as tolerated. Many patients return to work and normal activities the day after surgery, although a couple of days of rest and light duty are not uncommon. The stitches are removed 10-14 days after surgery and most patients have significant improvement of their symptoms by the time they are seen for the post-op appointment. Once the carpal tunnel is released, recurrence of carpal tunnel syndrome is rare.

Today both surgical and non-surgical treatment of carpal tunnel syndrome is relatively safe and simple. Surgical treatment has a very high rate of success and patient satisfaction with a low rate of complications and risk. Non-surgical treatments, while not a permanent cure, can provide significant relief of symptoms. If you are one of the millions affected with carpal tunnel syndrome, talk to your doctor about your options or get an opinion for a specialist.

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