Your Complete Guide to Carpal Tunnel Endoscopic Surgery

Did you know that 1 to 5% of all people will develop carpal tunnel syndrome at some point in their lives? If you have carpal tunnel syndrome or know someone who has it, you know that it can be a painful and frustrating condition. While some pain medications may be able to cover up the condition’s discomfort, they will not solve the root of the problem.

So, what treatment options are available for carpal tunnel syndrome? One of the most successful options, especially in severe cases, happens to be carpal tunnel surgery. There are two main types of carpal tunnel surgery: open and endoscopic, both of which can be very helpful. 

In this article, we will discuss a little bit about both surgery options so you can weigh the differences for yourself and see which option might be better in your case. We will also examine what carpal tunnel is, what causes it, and how to tell if surgery might be a good option compared to other treatment methods. 

To start off, let’s take a closer look at what carpal tunnel syndrome is exactly and why it might occur.

What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is not a normal ache in the wrist. Sometimes, the pain caused by this condition can be so severe that people with carpal tunnel syndrome might no longer be able to do the hobbies or work that they enjoy. But what is carpal tunnel syndrome exactly?

The root of the problem is with the median nerve. The median nerve is a nerve that passes through the bones and ligaments of your wrist and into your hand. It is also responsible for allowing most of the fingers of your hand, including your thumb, to move around. 

Without this nerve, you would be unable to grasp anything or perform any action that requires the use of your fingers and thumb. The median nerve also provides control to the anterior or front muscles of your forearm. While most discomfort associated with carpal tunnel syndrome is around the hand and wrist, because of the nerve’s path through the arm, the forearm can also experience problems. 

However, what happens to the median nerve that makes it cause all this trouble? In most cases, the median nerve is compressed by the surrounding bones and ligaments in the wrist. This can cause not only pain but also tingling and loss of sensation in the areas innervated by the median nerve. 

Even the slightest compression of the median nerve can cause pain and discomfort in the hand, wrist, and arm. This compression does not happen randomly, so what can cause it? Unfortunately, there is no one cause of carpal tunnel syndrome.

Instead, a variety of factors can contribute to its development. Let’s take a look at the various possible causes of this condition. 

What Are the Causes of Carpal Tunnel Syndrome?

For a long period of time, medical professionals were sure that the cause of carpal tunnel syndrome was repetitive movements. Some of these repetitive movements can include typing on the computer for long periods or performing other work such as writing with a pen. Because of this, many people at office jobs and other careers were recommended to take breaks from repetitive actions and stretch the muscles of their hands and wrists.

However, more recently, more and more medical professionals are starting to believe that carpal tunnel may not be caused by repetitive movements alone. Instead, genetics might play a bigger part than previously thought. This means, no matter what kind of job you might have, you may have certain genetics that predispose you to the development of carpal tunnel syndrome.

Overall, women tend to develop carpal tunnel syndrome more frequently than men. This is because their wrists are smaller in general and because of this, the median nerve can become compressed more easily. However, while this information may make you want to give up hope, there are other factors that contribute to the development of carpal tunnel, and many of these factors can be prevented. 

Other Causes of Carpal Tunnel Syndrome

For example, certain medical conditions may increase the risk of developing this condition. Rheumatoid arthritis, osteoarthritis, and thyroid conditions can all contribute to the development of carpal tunnel syndrome. This is most likely because these conditions tend to inflame certain parts of the body. 

Inflammation is often associated with dysfunction. Another cause is fluid retention which can put pressure on the median nerve. Fluid retention can occur from menopause or more serious conditions such as kidney failure. 

Damage to the wrist can also contribute to the development of this condition. Damage can include breaking your wrist or dislocating it. As your wrist heals, your carpal tunnel may not be as spacious as it once was and it may compress the median nerve. 

Your hands and wrists could also become damaged a little bit over time. This can occur when your carpal tunnel vibrates for long periods of time, such as when using a jackhammer. 

It’s important to remember that if you think you may be experiencing the symptoms of carpal tunnel syndrome, you shouldn’t always assume that it’s carpal tunnel syndrome. Instead, go to a doctor to make sure that your pain isn’t stemming from another condition. 

Speaking of symptoms, let’s take a better look at carpal tunnel symptoms before we dive into treatment options. 

Common Carpal Tunnel Syndrome Symptoms

While people with carpal tunnel syndrome can experience a variety of different symptoms, there are some symptoms that are more or less the same across cases. Remember that the condition is caused by the compression and dysfunction of the median nerve. Because of this, one of the first symptoms you may feel is a loss of sensation in your hand, fingers, and thumb. 

Some people experience numbness while others may feel an uncomfortable tingling instead. If you’ve ever fallen asleep on your arm before, you may already be familiar with the pins and needles feeling. Many people when developing this condition don’t take much notice of it. 

This is because the numbness and tingling often go away on their own as the day goes on. However, as the condition worsens, the numbness and tingling may worsen. If you’re unable to feel your fingers, you can imagine that it can become difficult to pick up and manipulate objects with your hands as you would normally. 

You may find that you’re only able to move your little finger correctly. This is because your little finger is not controlled by your median nerve but rather your ulnar nerve. Because of this, you may also not feel the same pain and numbness in your little finger as the rest of your hand and arm. 

Treatment Options for Carpal Tunnel Syndrome

Not everyone who develops carpal tunnel syndrome needs surgery. In fact, non-surgical options are usually sufficient. These can include a carpal tunnel brace, medication, or therapy. However, if these options don’t help your condition, surgery may be the next best option. 

As mentioned before, the two types of surgery for carpal tunnel syndrome are open and endoscopic surgery. Your doctor will be able to help you decide which kind of surgery is the best option for you. Both have more or less the same preparation. 

When you arrive at the hospital to get the operation done, you should keep from eating or drinking anything beforehand. The procedure is most often done using a regional anesthetic so you will not feel the operation but you will remain conscious. You can, however, request to be   with general anesthesia if you are very nervous about the procedure.

The surgeon sterilely prepare the part of your hand and wrist that will be operated on. As the name suggests, open carpal tunnel surgery involves cutting open your wrist with a large incision. On the other hand, endoscopic carpal tunnel surgery is far less invasive and involves much smaller incisions. 

Because of endoscopic carpal tunnel surgery’s less invasive nature, it will be easier to heal after the surgery. You will also have less scarring. Let’s take a closer look at endoscopic surgery. 

Understanding Endoscopic Carpal Tunnel Surgery

Endoscopic surgery involves the use of a small tool known as an endoscope. The endoscope is a hollow tube and on the end of it, a small camera is attached. This camera will allow the surgeon to take an up-close look at the inside of your carpel tunnel and especially at the transverse carpal ligament which often compresses the median nerve.   This is our preferred method of carpal tunnel release, unless there is a contra-indication to doing it.  One such instance is if you had previous surgery in the area, or a scar.  

By seeing these structures closer, the surgeon will be able to better determine the best course of action. The first step of this kind of surgery is creating a small incision below the beginning of your palm. This incision will act as the entryway for the endoscope once a cannula or hollow tube is placed inside the carpal tunnel.

Some doctors will stop at the first incision while others will create a second incision in the middle of the palm. However, thanks to advancements in technology, the second incision is becoming more and more unnecessary. 

Once the cannula is placed inside the carpal tunnel and the doctor has a chance to look around with the endoscope, a small and specialized knife will be slid into the cannula to enter the carpal tunnel. This knife is unique because it cuts backward thanks to a sharp hook. This hook ensures that only the carpal ligament of the wrist is cut and not any other important ligaments or tissues inside the wrist. 

As soon as the carpal ligament is divided, there will be an immediate release of pressure in the wrist. This release will ensure that the median nerve is no longer compressed. Because of this, the symptoms of carpal tunnel syndrome such as pain and numbness will gradually decrease and you will regain control over your hand and fingers. 

Recovering After Endoscopic Carpal Tunnel Surgery

After the carpal ligament is cut, the doctor will sew your incision shut, but not the ligament.  Our incisions are so tiny, they do not require any sutures, hence we call it the no stitch endoscopic carpal tunnel release.   The sliced ligament will heal on its own by forming scar tissue in the area where the cut was made. By keeping the cut ligament loose, it will ensure that the median nerve does not become compressed again. 

However, because your median nerve is no longer compressed does not mean that you can return to your work and hobbies right away. The recovery process can differ from person to person, but some guidelines remain the same. There are a few precautions you need to take to make sure your affected wrist heals in the right way.  In general, most patients that have the endoscopic carpal tunnel release at our office, return to work quickly.  Most patients can do unrestricted activities, one week after surgery.  However, that does not mean you will have no pain or weakness, it just means that you are cleared to try to do them.  

We do things to mitigate swelling post op. 

For example, to reduce swelling in your hand, you will need to keep your hand raised above the level of your chest for a few days. You should not perform any activities with your hand for some time. This shouldn’t be too difficult at first since your hand and wrist will be bound in bandages. 

After the anesthesia wears off from your surgery which can take a number of hours, you can treat the remaining pain with prescription pain medication. As the pain lessens over time, you can resort to over-the-counter pain medications. Using ice over the sight of your incision can also help to numb any pain.   Most patients having just an endoscopic carpal tunnel release, will be pleasantly surprised to see that the requirements for pain medicines are minimal.  

It’s important to remember that you should be patient during your recovery process. Some people can recover in a few months while others take an entire year to recover and return to their normal lives. 

Understanding Endoscopic Surgery for Carpal Tunnel Syndrome

You now know all about what carpal tunnel syndrome is, what causes it, and how it can be treated. You also know the details of endoscopic surgery for this condition. With this knowledge, you can make better decisions when it comes to carpal tunnel treatment. 

To know more, contact us here

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