- Carpal Tunnel Syndrome (CTS) is characterized by numbness and tingling in the hand, especially at night. It can cause one to wake from sleep and need to “shake the hand out” in order to make the tingling stop. The numbness and tingling from carpal tunnel syndrome is on the touch surfaces of the thumb, index, middle, and usually half of the ring finger. It can also cause weakness in the muscles used for opposition (the act of bringing the thumb pad to face the pads of the other fingers.)
- It is caused by compression on the median nerve as it crosses the wrist underneath the transverse carpal ligament. The ligament compresses the nerve causing a decrease in blood supply. Much like a foot falling asleep with crossed legs, the hand goes to sleep when the nerve is compressed.
- Left untreated, it can go on to cause irreversible nerve damage. Special nerve tests can be performed to assess the degree of damage or compression to the nerve. It can often be managed nonoperatively with splints and when necessary, surgery has a high rate of success in correcting the problem. The carpal tunnel release procedure consists of surgically dividing the ligament which is compressing the nerve. Once decompressed, the nerve can heal and often begins functioning normally again.
- In some cases, the scar can become thick and tender after carpal tunnel release. This is usually temporary and resolves with stretching exercises and scar massage. A silicone pad can also help. In an attempt to minimize scar pain, endoscopic carpal tunnel release can be performed which involves dividing the ligament from the inside out. This avoids the need to cut the skin overlying the ligament. In my opinion, there is a slight increase in the risk of incomplete release with this procedure which in some cases, could require an open procedure later.1 Choosing which procedure is right for you is something that you should take the time to discuss preoperatively.
1. Concannon, M. J.; Brownfield, M. L.; and Puckett, C. L.: The incidence of recurrence after endoscopic carpal tunnel release. Plast Reconstr Surg, 105(5): 1662-5, 2000.