What is Carpal Tunnel Syndrome?
The “carpal tunnel” is a tunnel-like structure of the wrist. The wrist bones called the carpal bones form the floor and walls of the tunnel. The roof of the carpal tunnel is a strong band of connective tissue called the transverse carpal ligament.
The median nerve travels through the carpal tunnel and this nerve provides sensation to the palm side of the thumb, index, middle and half of the ring finger. It also controls the muscles of the thumb. Flexor tendons travel through the carpal tunnel with the median nerve. These tendons are necessary to bend the fingers and thumb.
Carpal tunnel syndrome occurs when the tissues adjacent to the flexor tendons in the wrist swell and put pressure on the median nerve. These tissues are called the synovium and they lubricate the tendons to make it easier to move the fingers. With carpal tunnel syndrome, the synovium swells and narrows the confined space affecting the median nerve.
What is Involved with Endoscopic Carpal Tunnel Release Surgery?
Endoscopic surgery involves the use of a small camera. This small camera is known as an endoscope and it is guided through a one centimeter incision in the wrist to view the inside of the carpal tunnel. The endoscope allows the orthopedic hand specialist to see the structures of the wrist without opening the entire area with a large incision.
The transverse carpal ligament is cut during endoscopic carpal tunnel release surgery and this ‘releases’ the pressure that is on the median nerve and thus relieves carpal tunnel syndrome symptoms. The small incision made to the surgical site are closed with sutures and the ligament that was cut will eventually heal by being filled with scar tissue. This type of procedures is done on an outpatient basis, with most patients receiving sedation and arm “block”.
Why Is Carpal Tunnel Release Surgery Done?
If you still have symptoms even after a long period of nonsurgical treatment, your orthopedic specialist may recommend carpal tunnel release surgery. If there are signs of nerve damage, the surgeon may urge you to consider this procedure immediately. Another reason the surgery is done is that severe symptoms that persist restrict your activities of daily life.
How Well Does It Work?
Most people who have surgery for carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their hand afterwards. In rare incidences, however, the symptoms return or there is temporary loss of strength when gripping or pinching objects. The surgery works best when there is no nerve damage or serious damage to the internal structures of the wrist. If the muscles are wasted away or weakened before the surgery, there is more likelihood that there will be decreased hand strength and function after the procedure.
What Should I Expect After Surgery?
There is a shorter recovery period after an endoscopic surgical procedure than after open surgery. This is because the structures of the hand and wrist are not manipulated and there is less of an incision to heal. The pain and numbness due to nerve compression should be relieved immediately following the endoscopic carpal tunnel release surgery.
You will have to avoid heavy use of your hand for two or three weeks following this procedure. Your doctor will advise you on when you can return to work and this will depend on whether or not your dominant hand was operated on, what is involved in your work activities, and the effort that you put into your rehabilitation and physical therapy.
