Hand numbness and weakness can be maddening. Simple tasks like buttoning a shirt can be almost impossible. What is Carpal Tunnel Syndrome? What is Carpal Tunnel Surgery? What are the 5 major causes of numbness after Carpal Tunnel Surgery? Are there regenerative options? Let’s dig in.
What Is Carpal Tunnel Syndrome?
The carpal tunnel is a narrow passage on the palm side of your wrist. The tunnel is composed of tendons, ligaments, and bones as illustrated. The transverse carpal ligament makes up the root of the tunnel. The median nerve passes through this tunnel as it descends from the forearm into the hand.
Carpal Tunnel Syndrome is a painful medical condition of the hand and wrist that is caused by compression of the median nerve. It occurs in approximately 4% of the US population (1) and is the most common peripheral nerve injury (2). The median nerve has many important roles which include providing the sensations you feel on the palm side of your thumb, index, and third and fourth fingers. Symptoms of Carpal Tunnel Syndrome include numbness and tingling in the palm, thumb, index, and middle fingers. The symptoms may also extend into the forearm and elbow. In some cases, the muscles of the hand get small and there is accompanying weakness.
Related: Tendonitis vs Carpal Tunnel
What Is Carpal Tunnel Surgery?
Carpal Tunnel Surgery is an outpatient surgery where the transverse ligament is cut. This ligament compromises the roof of the carpal tunnel which is intended to release the pressure and irritation of the median nerve. There are many different techniques with open surgery and endoscopic surgery being the most common.
What Are the Side Effects of Having Carpal Tunnel Surgery?
There are numerous side effects of Carpal Tunnel Surgery. The most common include (3):
- Infection
- Nerve damage
- Instability in the wrist bones due to cutting a critical ligament. This, in turn, can lead to additional injuries and arthritis (4)
- Failure of the procedure to relieve symptoms
- Pain at the surgical site scar
- Complex Regional Pain Syndrome (CRPS). A very painful and difficult condition to manage where the pain is out of proportion and can be accompanied by changes in skin color and temperature
Why Is there Numbness after Carpal Tunnel Surgery?
There are a number of reasons for numbness after Carpal Tunnel Surgery. The 5 most common causes that you must know are:
- Median nerve Inflammation and swelling from the surgery itself. This can lead to scarring of the median nerve with the return of symptoms including numbness.
- Surgical error or failure to relieve nerve compression. In one study this occurred in 25% of patients in the study (5).
- Carpal tunnel syndrome was the wrong diagnosis. Said another way the patient’s symptoms were not due to compression of the median nerve.
- Nerve entrapment at the level of the elbow and shoulder. As nerves transverse through the shoulder, down the arm, across the elbow, and into the forearm they wind through tight areas. These are areas where the nerve can be compressed or irritated resulting in numbness in the hand.
- Irritation of nerves in the neck (cervical spine). Disc protrusions, herniations, and joint overgrowth all can cause nerve compression resulting in hand and finger numbness.
Does Numbness after Surgery Go Away?
The short answer is not always. Whether or not numbness after Carpal Tunnel Surgery goes away is dependent upon a number of factors. The major factors include the type of surgery used, the severity of the median nerve compression, the presence or absence of muscle atrophy, and finding on electrical nerve studies. Patients with muscle atrophy, diabetes, thyroid disease, and heavy or repetitive work activity are prone to poor surgical outcomes. In a recent study, 1194 hands with documented Carpal Tunnel Syndrome were evaluated at 1,3,6, and 12 months after surgery (6). Symptoms including numbness lasted on average 42.4 months after surgery.
Is There a Regenerative Option?
Yes! At the Centeno-Schultz Clinic, we are experts in the diagnosis and treatment of Carpal Tunnel Syndrome and other nerve injuries. We use a breakthrough technique that uses patients’ own platelets and growth factors in the treatment of carpal tunnel syndrome. It is called Perc-Carpal Tunnel Orthobiolgic Scar Release (Perc-CT SOR Procedure) which has been used successfully for many years with excellent results. Instead of using high dose steroids which can damage tendons and deplete local stem cell stores, a patient’s own platelets are concentrated and injected around the inflamed median nerve. Platelets are rich in growth factors including PDGF and NGF which can reduce inflammation, increase blood flow, and help heal nerve dysfunction (7,8). The use of a patient’s own platelets has been shown to be superior to steroid injections in the treatment of carpal tunnel syndrome (9,10). The procedure involves identifying and injecting PRP around the median nerve under MSK ultrasound. The injected PRP can free up the scarred median nerve allowing it to move more freely. The procedure is challenging and can not be performed by your PCP or your orthopedic surgeon. To see the procedure please click on the video below.
In Conclusion
The carpal tunnel is a narrow passage in the wrist which is composed of tendons, ligaments, and bones. The median nerve passes through this tunnel as it descends from the forearm into the hand. Carpal Tunnel Syndrome is a painful condition of the hand and wrist that is caused by the compression of the median nerve. Symptoms include numbness and tingling in the palm, index, and middle finger. Shrinkage of hand muscles can occur. Carpal Tunnel Surgery involves decompressing the median nerve by cutting the transverse carpal ligament. There are different surgical techniques. Side effects are significant and include infection, nerve damage, wrist instability, painful scar, and CRPS. Numbness can persist after surgery. The five most common causes are median nerve inflammation, surgical failure, incorrect diagnosis, nerve entrapment in the shoulder or elbow, and irritation of nerves in the neck. The Perc-Carpal Tunnel Orthobiolgic Scar Release is a novel, non-surgical treatment option for carpal tunnel syndrome that uses a patient’s own platelets. The platelets are rich in growth factors that can increase blood flow and accelerate nerve healing. Patients avoid the risks and downtime associated with Carpal Tunnel Surgery.
If you are limited by hand pain and numbness due to carpal tunnel syndrome please know that effective nonsurgical options exist. Schedule a telemedicine consult with a board-certified, fellowship-trained physician who can review your regenerative options. Release yourself from the pain and limitation now.
1. 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
2.Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. 2008;77(1):6-17.
3.Karl JW, Gancarczyk SM, Strauch RJ. Complications of Carpal Tunnel Release. Orthop Clin North Am. 2016 Apr;47(2):425-33. doi: 10.1016/j.ocl.2015.09.015.
4.Fuss FK, Wagner TF. Biomechanical alterations in the carpal arch and hand muscles after carpal tunnel release: a further approach toward understanding the function of the flexor retinaculum and the cause of postoperative grip weakness. Clin Anat. 1996;9(2):100-8.
5.Stütz N, Gohritz A, van Schoonhoven J, Lanz U. Revision surgery after carpal tunnel release – Analysis of the pathology in 200 cases during a2 year period. J Hand Surg Br 2006;31:68-71.
6.Kim DH, Cho BM, Oh SM, Park DS, Park SH. Delayed improvement after endoscopic carpal tunnel release. J Korean Neurosurg Soc. 2014;56(5):390-4.
7.Sowa Y, Kishida T, Tomita K, Adachi T, Numajiri T, Mazda O. Involvement of PDGF-BB and IGF-1 in activation of human Schwann cells by platelet-rich plasma. Plast Reconstr Surg. 2019 Aug 27. doi: 10.1097/PRS.0000000000006266.
8. 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..
9. Senna MK, Shaat RM, Ali AAA. Platelet-rich plasma in treatment of patients with idiopathic carpal tunnel syndrome. Clin Rheumatol. 2019 Aug 16. doi: 10.1007/s10067-019-04719-7.
10. 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.
