It seems we hear about it in increasing frequency nowadays; a friend or family member is scheduled for carpal tunnel surgery. What is carpal tunnel, and why is it becoming so commonplace?
There actually is a carpal tunnel, which is a small duct at the base of the hand where the median nerve and tendons lie. When these tendons become aggravated, the tunnel may decrease in size due to swelling which in turn squeezes the median nerve. This condition can cause numbness and/or weakness in the hand and wrist and pain. Causes are varied, although popular belief that repetitive movement is one that has little clinical data to back it up. Many doctors hold that people who develop carpal tunnel syndrome are actually predisposed to do so as their carpal tunnels are simply smaller than those of other people.
Before recommending carpal tunnel surgery, doctors generally provide an extremely thorough examination to rule out bursitis or tendonitis, which mimic the symptoms of carpal tunnel. The Tunnel test and the Phalen test are two common procedures used to make the diagnosis. The Tunnel test involves a tapping on the median nerve; if substantial tingling or an electric shock-like feeling is experienced by the patient, the test is positive for carpal tunnel syndrome. Another test is the Phalen, which requires the patient to place the back of the hands together at the carpal site, lift the arms over the head and point the fingers of both hands downward and away. The existence of any tingling or numbness after one minute could indicate carpal tunnel syndrome.
When carpal tunnel surgery seems the only recourse to alleviate the pain and numbness, it usually means the patient has been treated under alternative methods unsuccessfully. There are two procedures considered for carpal tunnel surgery. The first is an open release surgery, the most traditional method. A two inch incision is made to facilitate the cutting of the carpal ligament, which enlarges the carpal tunnel. The advantage to this procedure is the out-patient status and minimal anesthesia.
The second method for carpal tunnel surgery is endoscopic. This procedure generally has a quicker recovery rate and less post-surgery pain. Two small incisions are made with this method; one in the wrist and one in the palm of the hand. A miniscule camera attached to a delicate tube is inserted to provide the surgeon a close-up view on a screen of the carpal ligament, which is cut to open the tunnel. The endoscopic method also uses local anesthesia as an out-patient and results in less scar formation.
The best way to treat carpal tunnel surgery is in prevention; however, when carpal tunnel surgery is required, it is comforting to know that the majority of patients have a full recovery. Maintaining a safe workplace and supporting your wrists may mean that carpal tunnel surgery can be avoided.
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