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About Carpal Tunnel

Carpal tunnel syndrome, also known as median nerve compression, is a condition which affects the hand. The median nerve is located on the palm side of your hand which is also known as the carpal tunnel. The median nerve is responsible for providing sensation to the thumb, the index finger, and parts of the ring finger. The nerve is responsible for the muscle going to the thumb. Carpal tunnel syndrome is usually accompanied by sensations of pain, tingling, burning or swelling in the palm of the hands and may extend to the first three fingers of the hand and the thumb.

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Overview

Carpal Tunnel Syndrome
Carpal Tunnel Surgery Incision
  • Incision in open carpal tunnel release surgery is about 2 inches.
  • In endoscopic carpal tunnel release, the doctor makes two incisions of half-inch each
Restrictions after Carpal Tunnel Surgery
  • Avoid lifting things heavier than 0.5 to 1 kg and overusing your hand for about 2 weeks.
  • Avoid doing repeated arm or hand movements, and activities like typing or using a computer, or chopping food.
  • Avoid activities that cause vibration in the hand.
Carpal Tunnel Surgery- Endoscopic vs Open Surgery
  • Incision size- Size of open carpal tunnel surgery incision is usually 3 to 4 cm. Endoscopic carpal tunnel incision size is approximately 1 cm, which is much smaller.
  • Blood loss- Due to the smaller incisions, there is minimal blood loss in case of endoscopic carpal tunnel surgery.
  • Recovery Period- Recovery period after endoscopic carpal tunnel release is much smaller as compared to open surgery.
  • Risks and complications- Risk of infection, complications, hand pain and scar tenderness is higher following an open surgery as compared to endoscopic surgery.
Carpal Tunnel Syndrome Management
  • Wearing a wrist splint to put it in a neutral position
  • Ultrasound therapy
  • Oral corticosteroids
  • Local steroid injections
  • Anti inflammatory medications
  • Surgery
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Treatment of Carpal Tunnel Syndrome

How is Carpal tunnel syndrome diagnosed?

A doctor can diagnose carpal tunnel syndrome by doing a physical examination and tests called nerve conduction studies. The physical examination may include a thorough evaluation of your hand, shoulder, wrist, neck or any other parts that can cause pressure in the nerve. The doctor may also check if there is any tenderness or swelling in the wrist. The doctor may further check the sensation of the fingers and the strength of the muscles in your hand.

Carpal Tunnel Release Surgery

A doctor can diagnose carpal tunnel syndrome by doing a physical examination and tests called nerve conduction studies. The physical examination may include a thorough evaluation of your hand, shoulder, wrist, neck or any other parts that can cause pressure in the nerve. The doctor may also check if there is any tenderness or swelling in the wrist. The doctor may further check the sensation of the fingers and the strength of the muscles in your hand.

To relieve the symptoms of carpal tunnel syndrome, the doctor conducts a surgery called Carpal Tunnel Release surgery. During a carpal tunnel release or surgery, the surgeon cuts through the ligament that is pressing down on the carpal tunnel. This makes more room for the median nerve and tendons passing through the tunnel, and usually improves pain and function.

When does a person require a carpal tunnel release?

The doctor might suggest a carpal tunnel release when:

  • The nonsurgical interventions for carpal tunnel syndrome fails to provide relief from the pain.
  • The muscles of the hands or wrists are weak and actually getting smaller because of the severe pinching of the median nerve.
  • The symptoms of carpal tunnel syndrome have lasted 6 months or longer with no relief.
  • The doctor performs an electromyography test of the median nerve and determines that you have carpal tunnel syndrome.

In Our Doctor's Word

Dr. Ashish Taneja

MBBS, MS - Orthopaedics

17 Years Experience

"The prevalence of Carpal Tunnel Syndrome is 2.7% to 5.8% in general population. In Inida alone, there are several people suffering from Carpel Tunnel Syndrome and most of them kleep delaying their treatment because of some misconceptions. But the truth is, most of the cases can be treated with the help of medications, surgery and physiotherapy. But, since patients do not approach us on time, the delay severs the condition and makes difficulty to treat. See, the symptoms usually begin through an abnormal pain or swelling around your wrist. If you are experiencing any, do not wait for it to get worse/ self diagnose. See a specialist as soon as possible., because they are the one who can really treat or cure your condition."

Frequently Asked Questions

Can carpal tunnel go away without surgery?

If diagnosed early, when the symptoms are not too severe, and the condition is beginning, carpal tunnel syndrome can be managed with medicines and carpal tunnel exercises. It takes over six months to manage carpal tunnel syndrome pain without surgery. However, surgery is definitely required for patients with severe pain and symptoms.

Does massage help carpal tunnel syndrome symptoms?

Massage therapy is among the most effective and affordable treatments for early-stage carpal tunnel syndrome. During the massage, the therapist performs deep tissue therapy to release adhesions, trigger points and tension in the affected region. For carpal tunnel, massage is performed on the neck, shoulder and arm.

Do you massage the wrist with heat or ice?

Most carpal tunnel experts agree that heat massage works better to relieve carpal tunnel pain than ice. While ice can provide momentary relief, heat ultimately promotes healing by increasing blood flow and reducing inflammation in the area.

Why are carpal tunnel symptoms worse at night?

At night we are still, and so is the tissue fluid in the arms as the muscle pump is inactive at this time. Due to this, the amount of tissue fluid in the carpal tunnel increases as well and leads to increased pressure in the carpal tunnel area. Hence, the pain gets worse at night.

Is carpal tunnel syndrome related to arthritis?

Carpal tunnel syndrome is not a kind of arthritis. However, it can occur as a result of arthritis. This is because arthritis causes swelling in the wrist and tendons of the carpal tunnel and bony spurs in the wrist bones around the carpal tunnel.

Can carpal tunnel syndrome be caused due to typing?

Carpal tunnel syndrome can be caused due to repetitive motion of the wrist and arms. Typing increases the risk of a repetitive strain injury, which can compress the median vein and nerve and lead to CTS.

Can CTS happen in children?

In children, the chances of carpal tunnel syndrome occurrence are very rare. CTS can only occur in children due to inherited conditions such as lysosomal storage disease, which causes inflammation in the joints.

Can carpal tunnel affect the entire arm?

In severe stages, the pain from carpal tunnel can radiate up to the entire arm and the shoulder and even the neck in rare cases.

Are there any diseases that can be misdiagnosed as carpal tunnel syndrome?

CTS is often misdiagnosed as it exhibits symptoms similar to other conditions like arthritis, wrist tendonitis, repetitive strain injury (RSI) and thoracic outlet syndrome, such as tingling, pain numbness, hot-or-cold sensations, and difficulty in gripping stuff.

Is carpal tunnel surgery painful?

Endoscopic carpal tunnel release surgery is performed under local anesthesia. It is a minor surgery that is entirely painless. Open surgery causes more pain compared to endoscopic surgery.

What is the cost of carpal tunnel surgery in Agra?

The average cost of carpal tunnel release surgery in Agra is around INR 35,000-INR 55,000. This is the average cost of the package and can easily vary depending on a lot of other factors such as the severity of the condition, technology used, hospitalization fees, etc.

How long does carpal tunnel surgery take?

Carpal tunnel surgery does not take over 15-20 minutes per hand. The patient spends around 45-60 minutes in the operation theater for the entire procedure before being moved to recovery.

What does the recovery for carpal tunnel release surgery depend on?

The recovery for carpal tunnel release surgery depends on how long the patient had the condition and what kind of procedure they had. If the nerve had been compressed for a long time and the patient had open surgery, then it would take much longer to heal. It also depends on your dominant hand and what kind of work they do.

How soon can I go back to work after carpal tunnel surgery?
  • If the surgery is on the dominant hand and the patient has to perform repetitive motions such as typing and assembly-line work, then they can go back to work in 6-8 weeks
  • however, if it is on their non-dominant hand and they don’t need to perform repeated motions, they can go back to work in 7-10 days.
Can carpal tunnel syndrome lead to permanent disability?

Carpal tunnel syndrome can lead to permanent nerve and muscle atrophy if not treated in time. In some cases, the damage is irreversible even after surgery. Connect with the best orthopaedic surgeons in Agra for the best carpal tunnel treatment near you through Pristyn Care.

Will I be awake during carpal tunnel surgery?

The surgeon can perform the surgery under general or local anesthesia depending on the patient’s condition and the surgeon’s preference. If the surgery is performed under local anesthesia, you may be awake, but you won’t feel any pain during the surgery.

Why is carpal tunnel syndrome more common in pregnant women?

Pregnant women often have more hormonal changes that affect fluid retention in their bodies which can lead to compression of the median nerve. If you think you might have pregnancy-induced carpal tunnel syndrome, you should consult your doctor and seek treatment immediately.

What are the major risk factors associated with carpal tunnel syndrome?

Risk factors associated with carpal tunnel syndrome are:-

  • People with small carpal tunnels hereditarily are more likely to get carpal tunnel syndrome.
  • Women are three times more likely to get carpal tunnel syndrome, especially during pregnancy due to constant hormonal fluctuations.
  • Patients between the ages of 40 and 70.
  • Wrist injury including sprained and fractured wrists.
  • Frequent exposure of hands to extreme temperatures.
  • Medical conditions such as overactive pituitary gland, hypothyroidism, rheumatoid arthritis, diabetes, etc.
  • Delayed complication of improperly managed Colles’ fracture.
  • Repetitive movements of hands or wrists.

What are the stages of carpal tunnel syndrome (CTS)?

There are three stages in carpal tunnel syndrome:

Stage 1- Mild symptoms

In the initial stage, most patients only feel numbness and tingling sensation. The condition is usually reversible in this stage. Symptoms most observed during this stage of the disease are:

  • Numbness or tingling of the palm and thumb, and fingers
  • Clumsiness- dropping things
  • Pain extending up to the elbow
  • Loss of finger coordination of the fingers in one or both hands
  • Weak grip

Stage 2- Moderate symptoms

Most people start noticing the symptoms of carpal tunnel in this stage, and hence it is the stage in which most people are diagnosed. The patients begin experiencing symptoms during the day as well as night and start having difficulty with everyday tasks such as getting dressed, holding small objects, driving, etc.

Stage 3- Severe symptoms

In the severe stage, the patients lose muscle function due to muscle atrophy. Symptoms during this stage include constant numbness and pain. In rare cases, the patient may not have complete muscle function even after surgery.

Complications of carpal tunnel release surgery

Endoscopic carpal tunnel release surgery is extremely safe, but in rare cases, it can be associated with certain complications such as:

  • Excessive bleeding
  • Infection
  • Injury to the median nerve to the surrounding blood vessels
  • Sensitivity to postoperative scar

The complications are much more prevalent in open surgeries or if the condition has gone untreated for a longer period of time. Recovery may take from a few weeks to a few months, and the patient needs to be very careful about the surgical site in this period.

Physiotherapy for carpal tunnel surgery

After carpal tunnel release surgery, if the patient does not follow proper rehabilitation and physiotherapy, then the recovery will take much longer. Physiotherapy helps avoid the build-up of scar tissue in the operated region and opens up the tunnel in the wrist to allow proper wrist function. It also helps regain a complete range of motion for the wrist. In addition to physiotherapy, patients should also wear assistive devices such as thumb splints to encourage recovery.

Common carpal tunnel syndrome exercises to follow after carpal tunnel surgery are:

  • Fingertip touching: Hold up your hand, with palm side up and touch your thumb with each fingertip in both directions to complete a full cycle. Perform this exercise 3 to 5 times.
  • Wrist flexion and stretch: Extend your arm with the wrist flexed at a 900 angle. Pull the wrist back by the other hand. Hold this position for 10-30 seconds 5-6 times for each hand.
  • Tendon gliding: Hold your hand straight up and bend your fingers at a 900 angle towards the first knuckle while keeping the fingers together. Then, bend them towards the second knuckle, then form a fist. Then open the hand and repeat the action 5-10 times.
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