Carpal tunnel syndrome (CTS) is a hand and arm condition causing pain, numbness, and other symptoms. It one of the most common soft tissue pathologies, affecting between .6–2 percent of the population. While it occurs most frequently in people over 40, it can affect anyone performing repetitive or forceful movements that induce wrist tissue inflammation. Some people are simply more prone to carpal tunnel syndrome due to obesity or small wrist structure.

Fortunately, CTS is becoming more treatable, allowing patients to rapidly return to normal life.


  • Pain in the wrist, particularly upon flexing wrist or fingers (downward motion)
  • Weakness of grip
  • Tingling or numbness of certain fingers
  • Referred pain in the arm, neck, and shoulder

Patients often suffer particularly severe nighttime pain, making sleep difficult.

Other markers of CTS include the location of finger tingling and numbness. Typically, the thumb, forefinger, middle finger, and adjacent half of the ring finger are affected because these areas are serviced by the nerve that passes through the carpal tunnel.

The carpal tunnel is a passageway through which flexor tendons and the median nerve reach the fingers. It is circumscribed by wrist bones on the bottom and the transverse carpal ligament on the top (as envisioned palm up). When this passageway becomes constricted due to thickening of irritated tendons or other swelling of tissues, the pressure on the median nerve can create the trademark pain, weakness, and numbness of CTS.

Carpal tunnel syndrome is generally an overuse syndrome. Assembly line workers, musicians, and others who use their hands in a repetitive motion over long periods of time, particularly when pressure is applied, are most prone to carpal tunnel irritation. Workers who use vibrating power tools are also prime candidates for CTS problems. But many others are susceptible for other reasons, such as obesity and gender (women are more prone due to their smaller anatomy).

A computer mouse can even be a culprit. Though studies have not yet proven that general computer use (keyboard-based) causes CTS, anecdotal evidence of a link is building as more people with computer-based jobs visit our practices.

Diagnosis
A syndrome, by definition, is a group of symptoms that may indicate a disease process. With the case of carpal tunnel syndrome, diagnosis is not automatic when numbness or pain, for example, are reported. To assess the pressure on the median nerve and its origins, we examine our patients using several tests, from electromyograms to hand manipulation to provoke symptoms. Combining these tests with patient history enables a diagnosis and points toward the best treatment options.

Once CTS is diagnosed, depending on severity and the time elapsed since onset, one or more of these therapies may be recommended:

  • stretching exercises
  • reduction in the movements that exacerbate the condition
  • oral NSAIDs
  • cortisone shots

If symptoms continue unabated for six months or more, surgery should be considered.

Timing is important. People who decide to put up with the pain and limited movement for too long risk muscle atrophy that can lead to more weakness and poorer recovery from the postponed surgery.

Surgical options
Traditionally, the Open Carpal Tunnel Release procedure, wherein a 3–4 inch incision is made into the base of the palm, has been the procedure of choice.

Now, however, the physicians at the Hand Surgery Specialists of Texas offer the No-Stitch Carpal Tunnel Release (CTR), an innovative surgical treatment for CTS that is minimally invasive.We have performed this minimally invasive No-Stitch procedure thousands of times over the last 15 years, with a success rate that matches that of the Open CTR procedure, but with fewer side effects.

How does No-Stitch Release work?
Open carpal tunnel surgery involves making a 3–4 inch incision, followed by severing the transverse ligament, which provides a "release" of the constricted passageway and pressure on the median nerve.

Today's technology has produced dramatically miniaturized cameras and instruments, allowing our surgeons to perform this release through endoscopy. In the No-Stitch procedure, two incisions of just 1/2 inch each are made in the palm and wrist, and the release is typically accomplished in 10 minutes. Patients are under twilight anesthesia and return home that same day.

What results can I expect?
In 98 percent of our cases, relief from nighttime pain is realized immediately, other symptoms abate within weeks, and normal hand strength is restored within 2–4 months of surgery.

Advantages of No-Stitch Procedure

  • Short procedure, under twilight anesthesia
  • Quicker return to normal movement
  • Minimal post-surgical swelling
  • Lower risk of scar tissue build-up after surgery
  • Negligible or invisible scar at surgical portals
  • High success rate in short- and long-term relief from CTS symptoms

In cases where prior surgery has left significant scar tissue or a patient has anatomical anomalies that prevent endoscopic insertion, traditional surgery may need to be performed.

For success, find the experts
Our surgeons at Hand Surgery Specialists of Texas have performed over thousands of CTS releases. When the No-Stitch option became feasible, our surgeons trained with the surgeons who originally developed and refined the procedure. We are dedicated to maintaining our outstanding record of providing pain relief and restored function to CTS patients over the past 15 years.