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CARPAL TUNNEL SYNDROME What is carpal tunnel syndrome? Carpal tunnel syndrome is the result of compression of the median nerve at the wrist. The median nerve provides sensation to the thumb, index, middle, and half of the ring fingers. It also gives motor function to muscles at the base of the thumb. The transverse carpal ligament, the roof of the carpal tunnel, is applying too much pressure on the nerve when the contents of the canal become inflamed. Symptoms Most common symptoms include: Numbness, tingling, and pain in the hand that can radiate up the arm This progresses to become nocturnal, often causing frequent sleep disturbances and awaking from sleep, and positional, such as when driving a car Over time symptoms can become constant and feelings of clumsiness or weakness in the hands may occur, caused by weakening of the hand muscles Treatment options Ergonomic changes to workspaces/activity modification Nighttime splints Preventing flexion of the wrist, which puts extra stress on the median nerve Cortisone injections Reducing inflammation in the carpal tunnel Surgical Releasing pressure applied by the transverse carpal ligament Nighttime splints Cortisone injections Cortisone injections are often given to help reduce inflammation within the carpal canal. This medication is injected with a local anesthetic. This will provide pain relief from the injection for a few hours following. It is common to have increased soreness for a few days after the injection. Onset of the medication may take up to a week before you begin noticing improvement. Symptom relief is variable, but averages from 1-3 months. Diabetics should use cortisone with caution, as it can increase blood sugar levels. Surgical treatment Often before surgery, an EMG study is performed to evaluate the severity of median nerve entrapment When other treatments have failed or symptoms are severe, surgical repair involves releasing the tight and thickened transverse carpal ligament Two options: Standard open carpal tunnel release Endoscopic carpal tunnel release Open carpal tunnel release The transverse carpal ligament is divided through an incision in the palm, which releases pressure on the median nerve This is an outpatient procedure performed under local anesthesia. We are able to give you some sedative medication through an IV to keep you comfortable. The procedure takes about 15-20 minutes to perform. Endoscopic carpal tunnel release This method uses a smaller skin incision and a camera, called an endoscope, to also divide the transverse carpal ligament, but from the inside out This is an outpatient procedure performed under a light sedation. Once you are comfortable, we use an injectable local anesthetic to numb the region. The procedure takes about 15-20 minutes to perform. Endoscopic carpal tunnel release Risks Anesthetic Infection Numbness Recurrence Post-operative care A soft dressing is applied after surgery. You will be able to use your hands for light activity later that day. Keep the surgical dressing and incision clean and dry. After 48 hours you may remove the soft dressing and your incision may get wet in the shower, but no soaking. Apply a band-aid to keep the incision clean if necessary. Approximately 10-14 days postoperatively you will return to Dr. Foad’s office for a follow-up visit and suture removal. CARPAL TUNNEL RELEASE POST-SURGICAL FAQ’S When do I see Dr. Foad after surgery? You will return to see Dr. Foad for your post-op visit about 10-14 days after surgery. When can I use my hand? You will be able to begin using your hands for light activities usually the night of surgery. You will have a soft bandage on the hand that leaves your fingers and wrist free to move. You can perform simple functions such as feeding yourself, brushing your teeth, carrying a cup of coffee, etc. and continue to increase those as tolerated. Why is my hand numb? The local anesthetic that is used during the procedure often leaves some or all of the fingers in your hand numb for many hours. This may last well into the night of your surgery. The numbness from the anesthetic usually wears off by the following morning, but it may last a little longer. The numbness from your carpal tunnel syndrome may take time to resolve depending upon how severe the symptoms were before surgery, and how long the problem has been going on for. This varies greatly from patient to patient, and may also be affected by your age. Each patient’s nerves recover at a different rate, so please don’t be discouraged if all of your pre-operative symptoms are not gone right away. Residual numbness usually resolves gradually over the ensuing weeks to months. How do I care for my dressings? You may begin to shower or bathe as soon as you like. If the original surgical dressing is still on, take care not to get it wet. After 48 hours, please remove your soft dressing. You may wash your incision in the shower, however, do not submerge the incision underwater for an extended period of time, such as in a pool or hot tub. When may I shower or bathe? You may begin to shower or bathe as soon as you like. If the original surgical dressing is still on, take care to not get it wet. After 48 hours and you have removed the dressings you may start getting it wet in the shower. Do not submerge the incision underwater for an extended period of time, such as in a pool or hot-tub. When do the stitches come out? Stitches will be removed at your post-op visit 10-14 days after surgery. What if my pain medication causes itching or nausea? It is not uncommon for pain medications to cause these two side effects. If you experience itching you may take Claritin or Benadryl to help with this. If you are experiencing nausea, a prescription for Phenergan (aka promethazine) was given for this purpose on the day of your procedure. Remember to take your pain medication with food to diminish the potential for nausea. What about swelling? Swelling is quite common following these procedures. Do your best to keep the hand elevated above the level of your heart. Moving the fingers to open and close into a tight fist is also encouraged. Taking ibuprofen (Advil, Motrin) in addition to your pain medication will help with swelling (note: do NOT take more acetaminophen/Tylenol as it is already a component in the prescriptions you were given) When may I drive? You may begin driving again when you feel comfortable behind the wheel AND you are no longer taking any of the narcotic pain medications. If you would feel comfortable driving next to yourself on the road, it is probably safe for you return to this activity. When can I go back to work? It depends on the type of work you do. Those with jobs that are more sedentary and do not require heavy loads on the hands are often able to start returning to their duties within 1-2 weeks. Jobs that involve extensive heavy lifting and strain on the hands may take 3-4 weeks before they are able to return to work functions more normally. This is something quite unique to every patient’s situation and can be discussed more specifically with Dr. Foad at your office visit.