Carpal Tunnel Surgery
Kent Chou, MD, is an orthopedic hand surgeon on staff at Banner Estrella Medical Center.
Question: I have carpal tunnel and am told I need surgery to fix it. What can you tell me about this surgery and how long to I have to wait afterward before I can return to work?
Answer: Carpal tunnel syndrome is a very common condition, affecting up to ten percent of the population, and is caused by increased pressure on the median nerve in the wrist.
Symptoms may include wrist pain and numbness or tingling of the fingers, especially at night. Daytime symptoms may be associated with activities requiring prolonged gripping such as driving, holding a newspaper, or using a hair dryer. Carpal tunnel syndrome is more common in people who have diabetes, rheumatoid arthritis, or thyroid conditions. Hand use over time may also play a role in its development.
Carpal tunnel syndrom may be treated both non-surgically and surgically, depending on the severity and duration of the condition. Non-surgical treatments include wrist splinting, anti-inflammatory medication, and steroid or “cortisone” injections. These treatments are generally more effective if the condition is mild and has not been present for very long.
Surgery for carpal tunnel syndrome, called carpal tunnel release, involves cutting a tight band of tissue (the transverse carpal ligament) overlying the median nerve. The procedure can be performed in several different ways. Open carpal tunnel release requires an incision of 1 to 1½ inches in length at the base of the palm, and is the technique of choice for most surgeons.
Endoscopic carpal tunnel release was first described in the early 1990s and requires either one or two smaller incisions and the use of a small camera called an endoscope. Some studies have demonstrated a quicker return to work following endoscopic carpal tunnel release. Yet another technique is the minimally open or “mini-open” carpal tunnel release, which requires a small, ½-inch incision in the palm and utilizes a special set of instruments for isolating and dividing the transverse carpal ligament. Surgeons who favor this technique claim that it combines the advantages of the open and endoscopic techniques.
Although no surgical procedure is uniformly safe or successful, the results of carpal tunnel release are typically excellent, regardless of the specific technique used. Mini-open and endoscopic techniques require smaller skin incisions, but all three techniques require complete division of the transverse carpal ligament beneath the skin in order to be effective. Most people who undergo carpal tunnel release are able to return to work within a few weeks, depending on the nature of their jobs. Those who work at a desk can usually return to work within two to four weeks, while those with more strenuous occupations may need longer.
Carpal tunnel release generally cures the condition, although a small number of patients may experience recurrent symptoms later in life.