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Dr. Belongie

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carpal tunnel


Compression of the median nerve, which runs from the forearm to the palm of the hand, can lead to symptoms of numbness, tingling, and pain in the hand. The median nerve is responsible for controlling the feeling along the palm side of the hand, along the thumb, index, and long finger.  This same nerve also controls the muscles around the base of the thumb.

So what causes compression of the median nerve?  The nerve passes through a narrow passageway in the wrist. Inflammation along this pathway or tendon thickening can crowd the space causing the symptoms of pain, tingling, burning, itching, and numbness that can progress to inability to loss of grip strength and atrophy of the surrounding muscles.

The underlying cause of carpal tunnel syndrome is often considered multi-factorial.  Some are born with a narrower carpal tunnel that may pre-dispose them to developing symptoms.  Other possibilities include a traumatic injury to the wrist and repetitive use. Several medical conditions including hypothyroidism, rheumatoid arthritis, diabetes, and hormonal changes related to pregnancy can also be linked to carpal tunnel syndrome.

Diagnosis is often made from a physical examination and electrophysiological tests known as EMG and NCV. Non-surgical treatment includes the use of a carpal tunnel brace to prevent the wrists from flexing, Non-steroidal anti-inflammatory medication, activity modification, and cortisone injections for some.

Surgery is reserved for those who fail non-surgical options.

A carpal tunnel release is performed on an outpatient basis using local or regional anesthesia.

Surgery involves making an incision along the palm side of your wrist and hand. Overlying the top of the carpal tunnel is the transverse carpal ligament. This structure is divided to decrease the pressure on the median nerve and create more room along the tunnel. The traditional method is an open incision of up to 2” in length to release the median nerve.  Another technique is the endoscopic method. With this approach a small camera is inserted after a small skin cut is made and through a second small skin cut the transverse ligament is excised.  There are advantages and disadvantages to both approaches.  This technique has potential quicker return to activity but also higher risk of more serious injury to median nerve.  A Limited Open Approach  combines the best of both techniques.

Many experience immediately relief of their symptoms following surgery. In some cases, it can take many months to see the end result of this procedure. Unfortunately, not everyone gets 100% relief.

As with any surgical procedure, there are risks that must be considered. Although unlikely, infection, further injury to nerves and blood vessels, and sensitivity along the incision site (scarring) may occur. There are also risks from anesthesia.

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