Treating carpal tunnel syndrome

Dr. Bert Perey, MD, FRCPC, Orthopaedic Surgeon

Duration: 4:48

For most people, Carpal Tunnel Syndrome will worsen over time without some form of treatment. The flexor tendons will naturally increase in size, as people age.

Although non-surgical treatment can often slow the progress of symptoms, it will rarely stop it completely.

Wearing a brace or splint at night will keep you from bending your wrist while you sleep. Keeping your wrist in a straight, or neutral, position reduces pressure on the nerve and carpal canal. Wearing a splint during the daytime can also be helpful to avoid extreme positions of wrist flexion or extension. Modification of your job or recreational activities may also slow the process of Carpal Tunnel Syndrome.

Anti-inflammatories may help relieve pain and inflammation. A cortisone injection into the carpal canal can act as a powerful anti-inflammatory and temporarily relieve symptoms.

All of these modalities will rarely lead to permanent resolution of symptoms.

The surgical procedure performed for Carpal Tunnel Syndrome is called a Carpal Tunnel Release. The decision whether to have surgery is based upon the severity of symptoms. When symptoms of Carpal Tunnel Syndrome occur on a daily basis and the non-surgical management options have failed, it is usually recommended that surgery be performed. Ideally, surgery should be performed when the numbness is intermittent and before there is any constant numbness in the hands. Once constant sensory changes have occurred in the hand, there may be permanent damage to the median nerve that cannot be improved through surgical decompression.

The results from surgery are usually the same, regardless of the frequency or severity of symptoms, as long as the sensation to the finger returns to normal between episodes.

Surgery involves releasing the pressure within the carpal tunnel by cutting the transverse retinacular ligament. This is usually done through a 2 centimetre directly over the ligament where the forearm meets the hand. Most surgeries are done in ambulatory care setting, using a local anaesthetic (just like the dentist).

The surgical procedure usually rakes less than 15 minutes. The wound can be closed with either dissolving or non-dissolving sutures.

Most patients do not require narcotic analgesic following surgery. A combination of Tylenol and an anti-inflammatory (ibuprofen, aspirin, Naprosyn) is usually sufficient.

Light washing of the wound is usually allowed after 48 to 72 hours. Patients are asked to avoid soaking the wound or exposing it to a dirty environment, for the first 10 to 14 days, and to aggressively move their fingers after surgery, to reduce swelling and prevent stiffness. Heavier activities may be painful, but these are permitted. Most patients are able to resume light activities within 3 weeks and heavier activities within 6 weeks.

The surgical site may remain tender for several months. There will be a localized area of hardness around the surgical site that usually gets worse for the first six weeks. This hardness will subside over the ensuing six to twelve months. Deep massage of the area is recommended after 2 weeks. This will accelerate the scar softening and decrease the local tenderness. Grip and pinch strength usually returns by about 3 to 6 months after surgery, although it may take longer in some patients. Resolution of intermittent symptoms of numbness is usually very rapid.

If patients have some degree of constant numbness in their hand, prior to surgery, this may not completely resolve over time.

Infection about the surgical site can occur and this is usually treated with a course of oral antibiotics. Increasing pain, redness, and drainage can be signs of infection. Concerns should be raised with your surgeon or Family Doctor, if this occurs.

Presenter: Dr. Bertrand Perey, Orthopaedic Surgeon, New Westminster, BC

Local Practitioners: Orthopaedic Surgeon