When Carpal Tunnel Surgery Is Needed
Carpal Tunnel Surgery
Carpal Tunnel Syndrome, or known as CTS is a common neurological disorders experienced by individuals who repetitively use wrist motions at work. Carpal tunnel surgery is the treatment of choice in chronic cases. These are cases when the CTS could not be managed by conservative treatments and severe symptoms are experienced.
Carpal tunnel surgery intends to release the nerve being compressed within the carpal tunnel. The affected nerve in this condition is the median nerve. This nerve supplies the sensation and motor functions to the thumb, index, middle and radial half of the ring fingers. Thus, those people who suffer from compressed median nerve experience some pain, tingling sensations and numbness on the palmar or volar aspect area of nerve distribution in the hand.
The hand plays an important role in our daily lives. Most of the tasks we do every day require hand functions. If these functions are being affected or deteriorated because of CTS then we seek ways on preserving and even regaining the important hand functions.
However, if conservative treatments fail to lessen the debilitating effect of CTS to an individual then a carpal tunnel surgery is the next best option. Conservative management such as work modifications, wrist immobilization, medications and physical therapy are especially done during acute phases. The severity of the condition is determined by the physician. For patients who present with a more severe affectation of the disorder, carpal tunnel surgery is being opted.
Carpal tunnel surgery is one of the most common hand surgeries. This surgery involves the cutting of the carpal ligament that roofs the tunnel in which the median nerve is being compressed. The tunnel is medically termed as the flexor retinaculum of the wrist. More than 50% of its post-surgery patients report that they are relieved from nocturnal pain after the having the procedure.
There are two approaches being used in performing the carpal tunnel surgery. The old and more traditional way is called the open carpal tunnel release surgery and newest procedure is termed as endoscopic (keyhole) carpal tunnel release surgery. Both surgeries, as their names implicate, results in the release of the compressed median nerve within the carpal tunnel.
The types of carpal tunnel surgery
The open tunnel release surgery. This is the more traditional carpal tunnel surgery performed in patients who suffer from CTS. Local anesthesia is used and it is done in an outpatient facility.
A surgical incision is made on the volar aspect of the hand extending from the hand creases to the wrist area. The length of excision is from one and a half inch to two inches. This kind of procedure is routinely done with less to no post-operative complications.
After the release of the median nerve, the surgical incision is being sutured. The suture is removed after 7 to 10 days post-op procedure. Like any other skin wounds, the site must be cleansed according to doctor’s advice to prevent any skin or wound infections. Wound care must be taken into serious consideration to avoid post-op complications despite the fact that it is considered a simple operating procedure.
For those who are concerned cosmetically, this kind of carpal tunnel surgery does result in an obviously visible scar on your palm area. That is why some would prefer to have the second kind of carpal tunnel surgery, which is the endoscopic or keyhole tunnel release.
Endoscopic or keyhole tunnel release surgery. This is the newest hand surgical procedure when it comes to carpal tunnel syndrome surgical management. This is a less invasive procedure as compared to the traditional open CTS release. However, local anesthesia is also used and it is done as an outpatient operating procedure.
The small incision made in this surgery is small enough for the endoscope to pass through. Endoscope is a small, pencil-thin tube surgical device used in surgical procedures to view internal parts of the body without doing lengthy skin incisions. The endoscope is inserted into the body through the keyhole then the area involved is viewed on a monitor.
Endoscopic carpal tunnel release uses two kinds of techniques. The first technique is the single portal technique wherein a small incision is made on the wrist area. The second is the two-portal technique in which small incisions are made on wrist and hand. The latter may be more preferred since this causes fewer traumas to the underlying tissues during the procedure. Aside from this procedure being less invasive than the open tunnel release, the scar resulting from it is relatively small and quicker to heal. Another advantage is that at 3 months after surgery, the hand is less painful since lesser structures were affected during the surgery.
The surgery permanently cuts the carpal ligament that is why after undergoing carpal release surgery patients experience marked decrease in grip strengths. But hand functions are being preserved or regained in a remarkable manner. This is why most surgeons prefer to do the release surgery over the more conservative treatments.