I Have Carpal Tunnel Syndrome, What are my Treatment Options?

Carpal tunnel syndrome (CTS) is a common problem resulting in numbness, tingling, pain, and weakness in the fingers of the hand or palm. These symptoms can be worse while sleeping or with repetitive activities.

CTS occurs when the median nerve, one of the major nerves in the arm, is compressed as it travels through the carpal tunnel. This nerve is usually compressed by the transcarpal ligament or flexor tendons in this area of the wrist. CTS affects more than 12 million people nationwide and will affect 10% of the population at some point in their lives.

I’ve Been Diagnosed With Carpal Tunnel Syndrome, Now What?

The treatment options for carpal tunnel syndrome vary depending on the severity and length of symptoms. Typically for patients with mild CTS or recent onset of symptoms, there will be a conservative course of care. This can include interventions like wrist braces (especially at night), activity modifications, stretching & strengthening exercises, medications or injections around the median nerve.

For patients with moderate to severe carpal tunnel syndrome, they will often be recommended for a surgical procedure to cut the transverse carpal ligament and relieve the pressure on the median nerve, allowing it to heal and the symptoms to abate.

This is typically recommended because advanced CTS can lead to permanent deficits in strength if left untreated. In fact, a recent literature review in the British Medical Journal of high-level evidence suggests that there is more evidence for carpal tunnel surgery than any other orthopedic surgery.

What Happens in Carpal Tunnel Release Surgery?

In traditional “mini-open” carpal tunnel release surgery, after a wrist incision is made the tissue is dissected until the transverse carpal tunnel ligament is visualized and cut. Then the subcutaneous tissues and skin are sewn back together. The wrist is typically immobilized for several months while the area recovers with a typical recovery with this type of procedure is 8 to 12 weeks.

Carpal Tunnel Release (CTR) with ultrasound guidance also involves cutting the transverse carpal ligament but does so with a less disruptive approach that allows for cutting only the transverse carpal ligament and not the surrounding tissues. When combined with ultrasound visualization, the procedure requires only a small wrist incision (refer to the image below). 

Consequently, patients are able to recover much faster after carpal tunnel release under ultrasound guidance compared to the more traditional approach and are typically able to return to normal daily activities in 3-6 days. This procedure can be performed in an office setting without general anesthesia and the associated expenses.

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Recovery in days, not months

Recovery in days, not months