Transcript CARPAL TUNNEL SYNDROME

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.