Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome occurs when the median nerve of the hand is compressed within the transverse carpal ligament at the wrist. The median nerve provides sensation to part of your hand and fingers. The carpal tunnel is the area in your wrist where the median nerve and many tendons traverse your wrist and go into your hand. It is a narrow and tight tunnel which is why carpal tunnel syndrome can happen so easily – any swelling in this area can pinch the nerve causing pain, numbness, tingling, or weakness.

How is Carpal Tunnel Release Surgery Performed?

Here is a surgical video of Dr. McClellan performing an open carpal tunnel release. The surgery is performed under regional anesthesia at Mon General Hospital in Morgantown West Virginia. It is day surgery and you get to go home about an hour after surgery. Dr. McClellan will keep you in a soft dressing for about 5 days and then you will start physical therapy. Stitches will stay in for about 10 days and be removed in the office.

 

What causes Carpal Tunnel Syndrome?

Carpal tunnel syndrome is most often associated with repetitive motion of the hand and wrist. Some of the more common causes are:

  • Typing
  • Sewing
  • Writing
  • Painting
  • Assembly line work
  • Use of tools (especially hand tools that vibrate)

How do I know if I have Carpal Tunnel Syndrome?

If you do one of the activities above or any activity where your hand moves repetitiously, you may notice that your hand is starting to feel weak or experience some form of numbness. In order to verify that you do have carpal tunnel you will need to see a physician.

What can I expect in my initial consultation?

During your initial consultation Dr. McClellan will ask you several questions about your symptoms and pain as well as perform several tests. First, he will check your Tinel’s sign by tapping over your median nerve. Next, he will perform the Phalen’s test by bending the wrist forward for 60 seconds to check for numbness, tingling, or weakness. If Dr. McClellan suspects that you do in fact have carpal tunnel, he will likely get you set up to have an EMG (electromyography) and a nerve conduction study done so that he can see exactly what is causing your discomfort.

What treatments are available?

The first line of treatment for carpal tunnel syndrome is conservative; typically a splint is prescribed to be worn during your daily activities. You may be asked to cut back on strenuous activity so that the swelling will go down.

The next step is a corticosteroid injection in the carpal tunnel area. This is usually a temporary fix and patients generally see symptoms of the syndrome return in several months.

Surgical intervention is the most common treatment for carpal tunnel syndrome. 

What can I expect from surgery and recovery?

Carpal tunnel release is a surgical procedure in which the transverse carpal ligament is divided. There are various methods to accomplish this; however, Dr. McClellan more often than not performs the open carpal tunnel release.

Open carpal tunnel release is generally performed under local MAC anesthesia at Monongalia General Hospital as an outpatient procedure (you do not stay overnight). An incision is made on the palm that is about an inch in length. Dr. McClellan gently divides the subcutaneous tissue, palmar fascia, and finally the transverse carpal ligament.

We will see you back in our office about 10 days for suture removal. Patients may return to work around this time as long as the work is non-repetitive. If you have surgery on your dominant hand or if your job involves a lot of repetitive motion you may return to work about 6 weeks following surgery. Hand therapy will be prescribed in order to speed up your healing time.

Contact our office for more information.

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