Carpal Tunnel Surgery

Carpal tunnel syndrome (CTS) or median neuropathy at the wrist is a medical condition in which the median nerve is compressed at the wrist, leading to pain, paresthesias, and muscle weakness in the forearm and hand. A form of compressive neuropathy, CTS is more common in women than it is in men and has a peak incidence around age 42, though it can occur at any age. The lifetime risk for CTS is around 10% of the adult population.




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Most cases of CTS are idiopathic (without known cause). Repetitive activities are often blamed for the development of CTS along with several other possible causes. However, the correlation is often unclear.

It is a multi-faceted problem and can therefore be challenging to treat. Still, there are a multitude of possible treatments: treating any possible underlying disease or condition, immobilizing braces, prioritizing hand activities, and ergonomics. Recent studies have shown that medications have not been able to modify the extent of the disease. Ultimately, carpal tunnel release surgery may be required in which outcomes are generally good.



The condition was first noted in medical literature in the early 20th century.


In carpal tunnel release surgery, the goal is to divide the transverse carpal ligament in two. This is a wide ligament that runs across the hand, from the base of the thumb to the base of the fifth finger. It also forms the top of the carpal tunnel, and when the surgeon cuts across it (i.e., in a line with the middle finger) it no longer presses down on the nerves inside, relieving the pressure.

There are several carpal tunnel release surgery variations: each surgeon has differences of preference based on their personal beliefs and experience. All techniques have several things in common, involving brief outpatient procedures; palm or wrist incision(s); and cutting of the transverse carpal ligament.

The two major types of surgery are open-hand surgery and endoscopic surgery. Most surgeons perform open surgery, widely considered to be the gold standard (test). However, many surgeons are now performing endoscopic techniques. Open surgery involves a small incision somewhere on the palm about an inch or two in length. Through this the ligament can be directly visualized and divided with relative safety. Endoscopic techniques involve one or two smaller incisions (less than half inch each) through which instrumentation is introduced including probes, knives and the scope used to visualize the operative field.

All of the surgical options typically have relatively rapid recovery profiles (days to weeks depending on the activity and technique), and all usually leave a cosmetically insignificant scar.


Efficacy

Surgery to correct carpal tunnel syndrome has high success rate, especially using endoscopic surgery techniques. Up to 90% of patients were able to return to their same jobs after surgery.In general, endoscopic techniques are as effective as traditional open carpal surgeries,though the faster recovery time typically noted in endoscopic procedures may be offset by higher complication rates.Success is greatest in patients with the most typical symptoms. The most common cause of failure is incorrect diagnosis, and it should be noted that this surgery will only fix carpal tunnel syndrome, and will not relieve symptoms with alternative causes. Recurrence is rare, and apparent recurrence usually results from a misdiagnosis of another problem. Complications can occur, but serious ones are infrequent to rare.

Carpal tunnel surgery is usually performed by a hand surgeon, orthopaedic or plastic surgeon; some neurosurgeons and general surgeons also perform the procedure.

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