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HomeSummaryReview of the conditionCharacteristics of carpal tunnel syndrome Types Similar conditions Incidence and risk factors Diagnosis Medications Exercises Possible benefits of endoscopic carpal tunnel syndrome Considering surgeryPreparing for surgeryAbout the procedureRecovering from surgeryRehabilitationConclusion

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Carpal Tunnel Syndrome: Minimally Invasive Endoscopic Carpal Tunnel Release

Edited By: Thomas Trumble, M.D.
Last updated Wednesday, October 11, 2006

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Figure 4 - Rest and bracing provides the best relief.

Review of the condition

Characteristics of carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a condition in which the median nerve is compressed so that the patients experience numbness, pain and occasionally weakness. The nighttime numbness often causes the patient to wake up and shake their hand. CTS usually progresses slowly over time but the rate varies widely. When the patient has to flex their wrist for an activity, i.e. holding a steering wheel or hair dryer, numbness can occur.

Types

Carpal tunnel syndrome can be mild, moderate or severe. Mild CTS is often causes intermittent numbness. In moderate CTS the symptoms cause frequent nighttime wakening. In severe CTS, the patients often notice weakness and they can drop objects without realizing it.

Similar conditions

Sometimes a pinched nerve in the neck (cervical radiculopathy) can cause hand numbness and the electrical test (EMG/NCV) can determine if this is present. Hand arthritis can cause hand pain but should not cause hand numbness.

Incidence and risk factors

CTS is very common with the peak incidence at age 55. Although both men and women can develop CTS, the condition is more common in women than in men.

Diagnosis

CTS is diagnosed by the patients history, physical examination and electrical diagnostic studies (EMG/NCV). The history of nighttime numbness, combined with an examination of tenderness over the wrist (Tinel's sign) and increase numbness with wrist flexion (Phalen's sign) help to make the diagnosis. In the Tinel's test, tapping the wrist often produces electrical like sensations going into the fingertips. The EMG/NCV is a test performed by a neurologist or physiatrist that measure the speed of nerve conduction. When there is pressure on the nerve the conduction speed significantly decreases.

Medications

Braces worn at night can be very helpful by decreasing the nighttime numbness and helping the patients sleep. Nonsteriodal anti-inflammatory drugs (NSAIDs) like ibuprofen can help to relieve the symptoms but they do not provide a cure. These medications can be helpful for short-term use but most patients usually do not take these medications on a chronic basis for their CTS because there can be side effects associated with chronic NSAID use.

Exercises

Exercises generally do not help because they increase the swelling around the nerve. Rest and bracing provides the best relief. (Figure 4)

Possible benefits of endoscopic carpal tunnel syndrome

Endoscopic carpal tunnel release (endo-CTR) releases the pressure on the nerve and restores its normal blood supply. Studies of endo-CTR have demonstrated that patients generally regain their original strength with significant improvement in their symptoms <sup>4</sup> <sup>3</sup>Therapy after surgery can help the patients reduce scar formation and increase their strength. The patients at home usually do these exercises. The patients can return to nearly all activities within several weeks. By three months, studies have shown that the patients have recovered to a point where there was no difference in sensation and strength when the hand with CTS was compared to the other hand that had no symptoms.

Surgery for carpal tunnel syndrome at the University of Washington

If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4537 to make an appointment.

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