Dr. Gregg Vagner explains the role the carpal tunnel plays in the function of your hand. He explains the symptoms of carpal tunnel syndrome and the treatments available at his Austin, TX, practice. Treatments include both surgical and non-surgical options.
Carpal tunnel syndrome refers to a compression of the median nerve in the carpal tunnel. The carpal tunnel itself is made up of the carpal bones at the bottom and this thick transverse carpal ligament at the top. Within the carpal tunnel run nine tendons and the median nerve, and it's compression of this median nerve that causes the symptoms of carpal tunnel. Anything that takes up extra room in the carpal tunnel can cause carpal tunnel syndrome. This can be inflammation of the tendons themselves, arthritis in the bones underneath, or a thickening of the transverse carpal ligament. Any of these conditions can cause the symptoms of carpal tunnel syndrome.
Patients with carpal tunnel syndrome normally complain of numbness in their fingers, specifically numbness in their index finger, their middle finger, and their thumb. This numbness can actually progress to causing numbness during the day, especially with certain activities such as grasping, like driving a car or doing your hair. A lot of times, patients will come to me and complain that their circulation isn't right, and they feel like they have to shake out their hands to get the circulation back in their hands. It's not their circulation at all. It's the nerve being compressed. Sometimes this can progress to weakness, where they feel like they can't hold items very well or they're dropping things a lot at home.
Treatment for carpal tunnel normally begins with anti-inflammatory medications such as Advil or Aleve. Next, I'll recommend to my patients that they try bracing, especially at night. The brace functions to keep the wrist in a neutral position, thus taking pressure off the median nerve while it's being worn. Sometimes your doctor will suggest that you try a cortisone injection, which is an injection directly into the carpal tunnel. This decreases the inflammation inside the carpal tunnel and gives the median nerve more room. However, the effects of the cortisone shot last two to four months on average. If you continue to have symptoms during the day and the other treatment options haven't worked for you, it might be time to consider your surgical options.
There are two primary ways to approach carpal tunnel surgery. The first is an open release, where we make an incision here in the palm. We take the incision down to the transverse carpal ligament, where we release this ligament. This opens up the carpal tunnel and gives the median nerve more room. But don't worry. The function of the hand and wrist is not affected by the release of this ligament.
The other way to approach carpal tunnel surgery is endoscopically. We make an incision here and hide it in one of the wrist creases. We then take a wrist endoscope, and we place the wrist endoscope into the carpal tunnel itself. A blade is deployed, and by pulling the endoscope out, we are releasing the transverse carpal ligament. In the same way, this opens up the carpal tunnel and gives the median nerve more room. And that's it. That's the entire procedure. It takes about 10 minutes, and most patients' symptoms are significantly improved within 10 days.
I hope this video helped you understand more about carpal tunnel syndrome. If you have any questions, please don't hesitate to contact your local hand surgeon.