Prevention
The best course of action is prevention. The goal is to reduce the amount
of trauma occurring to the tissues within the carpal tunnel. This can
be achieved by concentrating on four factors: Position, Repetition,
Speed, and Force. Position: Keep the wrist as straight as possible;
do not bend the wrist forward, backward, or sideways unnecessarily.
Use the whole hand and all fingers when grasping instead of just the
index finger and thumb. Certain exercises may help strengthen your muscles
so that you can maintain the proper position. Repetition: This is something
to avoid doing for extended periods of time. Carpal tunnel syndrome
is a "repetitive movement injury". Even light movements, if
repeatedly performed, may lead to this condition. Give your hands a
rest periodically. Speed and Force: Slowing down and easing up during
repetitive movements is essentially similar to resting since damage
to your tissues is reduced and recovery is enhanced. Use power tools
if possible to provide you with speed and force. But a note of caution
is due when using power tools: don't forget to use proper Position.
(back to top)
Diagnosis
If you have already developed symptoms which may be due to carpal
tunnel syndrome, there are three phases in wich a complete diagnosis
is made: History, Physical examination and Lab tests. History: The signs
and symptoms of carpal tunnel syndrome include tingling and numbness,
pain, and weakness of the hands and fingers. We may ask you what aggravates
the symptoms and what time of day are they worse. Physical examination:
During the examination we look for things like swelling and loss of
sensitivity in the hand. Lab tests: X-rays, nerve conduction testing,
and muscle testing (electromyogram) help to document the presence and
degree of tissue damage and whether complicating factors like fracture
and arthritis are also present. (back
to top)
Treatment
There are two broad categories of treatments available for carpal
tunnel syndrome and we will help you choose which of these is best for
you. Medical treatment involves the use of medications and or splints.
Medications can be used to reduce the swelling inside the carpal tunnel
and relieve the pressure on the median nerve. These medications may
be taken orally (non-steroidal anti-inflammatory drugs, which also reduce
pain) or injected directly into the wrist joint (steroids). Splints
help to keep the wrist in a straight or neutral positionand promote
healing by limiting the amount of movement occurring in the tissue of
the carpal tunnel.
Surgical treatment is reserved for those who have severe pain, persistent symptoms after medical treatment, or who are at risk of permanent nerve damage. The aim is to reduce pressure in the carpal tunnel by opening the roof of the tunnel. This is done by cutting the transverse carpal ligament. There are two types of surgical procedure: Open and Endoscopic; both take somewhat less than an hour to complete and may be scheduled as same day surgery. We can help choose the best type of surgery for you. (back to top)
Before
Surgery
Please make arrangements to be accompanied home by a responsible
adult after surgery. Do not eat or drink anything after midnight the
night before the procedure unless you are instructed otherwise. Wash
your arm the night before surgery. (back
to top)
At
Surgery
Anesthesia is administered prior to the actual procedure so you
don't feel pain during surgery. This may be local or regional, limited
to your hand and arm, or general, making you sleep during the procedure.
You may be given an intravenous line. A tourniquet is tied to your arm
to stop the bloodflow to your hand. The incision that is made in your
hand depends on the type of surgical procedure that has been determined
to be best for you. (back to top)
Open
Carpal Tunnel Release
An incision is made down the center of your palm. The ligament is
then cut to relieve the pressure in the carpal tunnel. The skin is then
closed with sutures. (back to top)
Endoscopic
Carpal Tunnel Release
A small incision is made along the crease on the front of your wrist
and a second small incision may be made across the center of your palm.
An endoscope and other instruments are inserted into the incision or
incisions. The endoscope contains a camera that sends a video image
to a monitor where your doctor can see the ligament as he cuts it. The
incisions are then sutured shut. If the endoscopic surgery cannot be
continued safely, your doctor will change to the open procedure. (back
to top)
Risks
of Surgery
The original symptoms may not be relieved, or there may be bleeding,
infection, or rarely, nerve and/or tendon damage. (back
to top)
After
Surgery
Immediately after surgery your hand will be bandaged and will be kept
elevated to keep the swelling down; you should maintain the elevation
when you are taken home. You may be given pain medications and be told
to use an ice pack. It is important to keep the dressing dry so cover
it with a plastic bag when bathing or showering. Dark blue or black
discoloration of the hand after surgery is normal.You will be told about
exercising your hand by opening and closing your fingers and squeezing
exercises. You will probably be able to start light activities in one
to two days. Avoid bending your wrist far forward or backward, and try
not to bump the area around the sutures. We will schedule follow-up
appointments so that we can make sure you are healing properly after
surgery.
CALL US IF YOU NOTICE
Pale blue or white hand, pain that increases for more than a day and is not relieved by medication, loss of sensation, throbbing, or excessive swelling in the hand, or fever over 100 º F. If any of these occur after surgery, CALL US (Union office: 908-964-6600, Bayonne office: 201-858-1500). (back to top)
Locations - Doctors - Procedures - FAQ - Forms