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Wrist pain can be debilitating and carpal tunnel syndrome is a very common cause of wrist pain. What is carpal tunnel syndrome?  What is carpal tunnel surgery?  What does carpal tunnel surgery recovery look like?  What are carpal tunnel surgery complications?  Are there any nonsurgical alternatives?  Let’s dig in.

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a painful wrist and hand condition that occurs due to compression of the median nerve as it passes through the carpal tunnel.  Symptoms include pain, numbness, and tingling in the thumb, index and middle finger.  Risk factors for CTS include obesity, repetitive wrist work, inflammatory arthritis,  and pregnancy (1).  The carpal tunnel is a narrow passageway located on the under-surface of the wrist.  The flexor retinaculum forms the root of the carpal tunnel.  A retinaculum is a thickened band of connective tissue that surrounds tendons thereby holding them into place.  Approximately 4% of adults will suffer from carpal tunnel syndrome at some point (2).

Carpal Tunnel Surgery

The goal of surgery is to release the pressure on the median nerve as it passes through the carpal tunnel.  This is achieved by cutting the flexor retinaculum which is the roof of the carpal tunnel. There are many different techniques which include open surgery and endoscopic surgery.

Open Surgery

This type of surgery involves an incision over the wrist.  The flexor retinaculum is cut and the incision is then closed.

Endoscopic Surgery

This type of surgery involves the use of a small camera that enables the surgeon to see the median nerve, ligaments, and tendons (3).

What Can I Expect After Carpal Tunnel Surgery and Recovery?

Carpal Tunnel surgery recovery times, pain and recovery are directly linked to the invasiveness of the procedure.  The more invasive a procedure, the longer the recovery time.  Conversely, the less invasive a surgery, the quicker the recovery.

Return to Work

The average time to return to daily activities was 16 days for patients who underwent endoscopic surgery vs 20 days for patients who had open surgery.

One Month

55% of patients who underwent open surgery were improved at one month.  In comparison, at one month 63% of patients who underwent endoscopic surgery reported complete relief of symptoms (4)

Six Months

66% of the patients who underwent open carpal tunnel surgery and 77% of patients with endoscopic release showed complete relief at 6 months.

Carpal Tunnel Surgery Complications

All surgeries are associated with risks and complications.  Carpal Tunnel Surgery complications include:

Pain in Surgical Scar

4 nerve branches are a risk for injury with a surgical incision which can result in pain at the site of the incision.

Complex Regional Pain Syndrome

A tragic painful syndrome characterized by pain out of proportion, swelling and vascular changes that can be difficult to treat and manage.

Instability of the Flexor Tendons

The retinaculum is cut and in doing so the flexor tendons are at risk for being cut and weakened (5).

Nerve Injury

Partial or complete sectioning of the median and ulnar nerve occurs in both endoscopic and open surgery with an incidence of 0.14% and 0.11 % respectively (6).  There is a greater risk of non-serious nerve injury with endoscopic release vs open surgery (7).

Vein Injury

Injury to the superficial vascular arch occurred in 0.02% of patients in a recent study (8).

Infection

Infection may involve the skin or deeper structures including muscles and bone, and can require antibiotics.

Persistence or Recurrence of Symptoms

Persistence of symptoms is the most common complication after carpal tunnel surgery due to incomplete sectioning of the retinaculum (9).

Wrist Instability

The stability of the wrist is dependent upon the integrity of the wrist ligaments.  Unfortunately in carpal tunnel surgery ligaments are cut putting patients at risk for wrist instability (9)

New Treatment Options

Carpal Tunnel surgery is not necessary for many patients.  In fact, the surgery is truly only indicated for those patients for whom the meaty part of their thumb has decreased in size as a result of compression of the median nerve.  A nerve signal is essential for the health and function of all muscles.

Do you have numbness in your thumb or index finger?  A new nonsurgical procedure is available in which under ultrasound guidance the scar tissue around the median nerve is broken up thereby reducing compression on the nerve. The procedure is called a Perc-Carpal Tunnel Orthobiologic Scar Release.  At the Centeno Schultz Clinic, we are experts in the management and treatment of carpal tunnel syndrome and other wrist injuries. The injection uses a patient’s own platelets which are rich in growth factors that can increase blood flow and reduce inflammation (10).  PRP has been shown to be superior to steroid injections in the treatment of carpal tunnel syndrome (11).  These injections are technically challenging and can not be performed by your PCP or orthopedic surgeon.  To watch a median nerve decompression please click on the video below,

 

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In Conclusion

Carpal tunnel syndrome is a painful wrist and hand condition that occurs due to compression of the median nerve.  Carpal tunnel surgery cuts the flexor retinaculum using various techniques which include open and endoscopic surgery.  Both relieve the pressure on the median nerve.  Carpal tunnel surgery recovery varies depending upon the technique utilized.  In general, the less invasiveness the surgery, the quicker the recovery. Carpal tunnel complications include a painful scar, CRPS, vein injury, nerve injury, infection, wrist instability and recurrence of symptoms.  Perc-Carpal Tunnel Orthobiologic Scar Release is a new procedure in which under ultrasound guidance the scar tissue around the median nerve is released along with the injection of a patient’s own platelets.  This procedure is a nonsurgical alternative for patients with carpal tunnel syndrome without the risks or recovery associated with open or endoscopic carpal tunnel surgery.

 


1Solomon DH, Katz JN, Bohn R, Mogun H, Avorn J. Nonoccupational risk factors for carpal tunnel syndrome. J Gen Intern Med. 1999;14(5):310–314. doi:10.1046/j.1525-1497.1999.00340.x.

2.Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J. 2012;6:69–76. doi: 10.2174/1874325001206010069.

3.Schmelzer RE, Della Rocca GJ, Caplin DA. Endoscopic carpal tunnel release: a review of 753 cases in 486 patients. Plast Reconstr Surg. 2006 Jan;117(1):177-85. https://www.ncbi.nlm.nih.gov/pubmed/16404264.

4.Malhotra R, Kiran EK, Dua A, Mallinath SG, Bhan S. Endoscopic versus open carpal tunnel release: A short-term comparative study. Indian J Orthop. 2007;41(1):57–61. doi: 10.4103/0019-5413.30527.

5. Chammas M, Boretto J, Burmann LM, Ramos RM, Neto FS, Silva JB. Carpal tunnel syndrome – Part II (treatment). Rev Bras Ortop. 2014;49(5):437–445. Published 2014 Aug 23. doi:10.1016/j.rboe.2014.08.002

6. Benson L.S., Bare A.A., Nagle D.J., Harder V.S., Williams C.S., Visotsky J.L. Complications of endoscopic and open carpal tunnel release. Arthroscopy. 2006;22(9):919–924. 24 e1-2.

7. De Smet L. Recurrent carpal tunnel syndrome. Clinical testing indicating incomplete section of the flexor retinaculum. J Hand Surg Br. 1993;18(2):189.

8. Sayegh ET, Strauch RJ. Open versus endoscopic carpal tunnel release: a meta-analysis of randomized controlled trials. Clin Orthop Relat Res. 2015;473(3):1120–1132. doi: 10.1007/s11999-014-3835-z

9. Vanhees M, Verstreken F, van Riet R. What does the transverse carpal ligament contribute to carpal stability?. J Wrist Surg. 2015;4(1):31–34. doi: 10.1055/s-0034-1398486.

10.Sánchez M, Anitua E2, Delgado D, Sanchez P, Prado R, Orive G, Padilla S. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opin Biol Ther. 2017 Feb;17(2):197-212. doi: 10.1080/14712598.2017.1259409.

11. Uzun H, Bitik O, Uzun Ö, Ersoy US, Aktaş E. Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome. J Plast Surg Hand Surg. 2017 Oct;51(5):301-305. doi: 10.1080/2000656X.2016.1260025.

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