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Minimally Invasive Surgery for Carpal Tunnel Syndrome

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Are you experiencing pain in your hands or wrists when doing the most basic things? If you have pain or you are struggling to perform simple daily tasks like brushing your teeth or driving your car, then you might be suffering from Carpal Tunnel Syndrome. Here are a few insights which might help explain about what is happening to you.

Carpal Tunnel Syndrome

The carpal tunnel is a small and narrow tunnel-like area inside your wrist where the median nerve travels. Running from your forearm to your hand, the median nerve controls the feeling in your palm, thumb, index and middle finger so you would feel numbness in those areas if your nerve is compressed. The carpal tunnel protects this median nerve and nine other minor tendons. The syndrome occurs when there is compression to the median nerve, especially if it is squeezed or pressed onto the wrist. This can also occur from the swelling and inflammation of other minor tendons and synovium (joint lining) issues.

What are the symptoms?

The compressed nature of the carpal tunnel and the median nerve affects movement and feeling in the palm of the hand or in the first three fingers. The most common symptoms are:

  • Your fingers feel awkward, as if they are thickening or becoming dysfunctional
  • Numbness and pain in the hand
  • Constant tingling
  • Pain traveling up the arm
  • The strength of your grip worsens. Forming a fist becomes difficult as well as grasping little objects
  • Weakness and cramping of the hand

These symptoms mostly occur during the night because most people sleep with a flexed wrist, which is the cause of over-compression. Some people might need to wake and shake their wrist, which helps to lessen the numbness. Some display symptoms while brushing their teeth or driving their car. It is a syndrome which can either persist or resolve itself. In severe cases, patients’ muscles at the base of their thumbs can waste away. Holding and gripping becomes more difficult or almost impossible. Some lose their sense of touch entirely, even unable to distinguish between hot and cold.

What are the causes and risk factors?

Carpal tunnel syndrome is more of a result of the increased pressure on the median nerve that occurs from over tightness of transverse carpal ligament. While many suffer from carpal tunnel syndrome due to constant use of computer and texting, other common factors which can influence the development of the syndrome are as follows:

  • Repeated flexing of the wrists
  • Other diseases like diabetes, rheumatoid arthritis or obesity
  • Repetitive stress injuries
  • A wrist fracture or dislocation
  • Heredity
  • Other diseases like diabetes, rheumatoid arthritis or obesity
  • Hormonal changes during pregnancy
  • Menopause
  • A cyst or tumor in the carpal tunnel
  • Frequent use of vibrating hand tools
  • Getting older: the syndrome is common among older age groups
  • Gender: women tend to suffer from it more than men

Minimally Invasive Surgery

In the past, relieving the nerve pressure a standard carpal tunnel release treatment consisted of in-patient surgery with a long 3-5 cm wound incision. Because of the long incision and wide dissection, surgeries have to be operated under adequate general or regional anesthesia. The surgeries had wound complications such as wound dehiscence and painful scars. In 1988, Minimally Invasive Surgery (MIS) was introduced as a method to reduce these complications and it became more widespread in hospitals around the world. In 2008, a newly advanced technique – now widely known as the Wongsiri technique – became introduced in Minimally Invasive Surgery (MIS) medical reports. This new technique had superior outcome over open standard carpal tunnel release. Because of the key hole incision, less injury to the body is made when compared to open surgery. Most of the patients do not need general anesthesia, do not need to stay in hospital, and moreover, they experience early recovery within a few days at home with less wound pain. Another special tool (special thin visualization tube and special micro knife) is passed through the area and allow doctors to have a more specific view of the operating area and release specifically on the overly tight transverse carpal ligament. The goal of advanced MIS is to achieve a high level of success for complete release surgery, with more benefits for the patient and less downtime.

How is it done?

The Wongsiri technique and the minimally invasive surgery is becoming a more appealing treatment

option for carpal tunnel syndrome. The patient is first put under local anesthesia; the surgeon then creates one small incision in the wrist. The specially designed visual tube is passed through and the surgeon then cuts the transverse carpal ligament inside the carpal tunnel which caused is the cause of the pain and the compression on the median nerve.

What are the benefits?

Minimally invasive surgery is the commonly prefered treatment for carpal tunnel syndrome due to the following reasons:

  • The patient may experience less pain after MIS surgery than open surgery
  • Scarring is minimized
  • Less blood loss and complication
  • Allows the patient to resume normal activities more quickly
  • No extra cost spent on hospital admission, general anesthesia and other areas.

Recovery

Minimally invasive surgery allows for a smoother and faster recovery time for Carpal Tunnel Syndrome patients. There might be some initial soreness or stiffness and some patients might be required to undergo physical therapy after the surgery to regain strength in the wrist. Possible complications include bleeding, nerve damage or infection. Your doctor is the best person to advise you on how to proceed, especially in regards to resuming your work or daily activities.

References.

  1. National Institute of Neurological Disorders and Stroke – Carpal Tunnel Syndrome Fact Sheet.  Available from http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm. Accessed on April 9, 2015.
  2. OrthoInfo: American Academy of Orthopaedic Surgery – Carpal Tunnel Syndrome. Available from http://orthoinfo.aaos.org/topic.cfm?topic=a00005. Accessed on April 9, 2015.
  3. Mayo Clinic – Diseases and Conditions – Carpal Tunnel Syndrome. Available from http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/definition/con-20030332.  Accessed on April 9, 2015.
  4. Ethicon – Minimally Invasive Surgery. Available from http://www.smarterpatient.com/patients/learn-more/minimally-invasive-surgery. Accessed on April 9, 2015.
  5. American Association of Neurological Surgeons – Minimally Invasive Surgery. Available from http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Minimally%20Invasive%20Spine%20Surgery%20MIS.aspx. Accessed on April 9, 2015.
  6. Patient – Minimally Invasive Surgery. Available from http://www.patient.co.uk/doctor/minimally-invasive-surgery. Accessed on April 9, 2015.

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Asst.Prof. Sunton Wongsiri, M.D. Summary: Orthopedics Orthopedics