HAND & WRIST
Carpal Tunnel Release
Carpal tunnel release is an outpatient procedure performed to relieve pressure on the median nerve and reduce the symptoms of carpal tunnel syndrome. This procedure can help restore muscle strength and dexterity, and is typically performed on patients who have had persistent symptoms that do not respond to conservative treatment methods.
Carpal tunnel release can be performed endoscopically or through an open procedure. Both types offer different advantages to the doctor and patient, and should be considered after a thorough evaluation of the patient’s individual condition. Open carpal tunnel release involves a two inch incision in the middle of the palm and gives the surgeon a better view of the treated area with less risk of accidentally damaging nerve tissue. Endoscopic carpal tunnel release involves two tiny incisions and offers patients less post-operative pain and the ability to return to work more quickly.
Patients can return home the same day, but may need prescription pain medication at first to manage the pain from the procedure. The hand may be kept in a splint for the first few weeks after surgery in order to protect the wrist while it heals. Although patients may continue to experience carpal tunnel symptoms after this procedure, most report that symptoms are significantly reduced after carpal tunnel release.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common condition involving numbness, pain, tingling and instability in the wrist, hand and fingers. It occurs when pressure is put on a nerve in the wrist called the median nerve, which controls motor function in the wrist and hand. This pressure, called impingement, is most often caused by bone spurs, rheumatoid arthritis, repetitive use or injury.
Carpal tunnel syndrome can be diagnosed with tests such as an electromyogram or a nerve conduction study. It can often be effectively treated with nonsurgical therapies such as wrist splints, anti-inflammatory drugs or corticosteroids. In cases where pain and numbness persist, surgery (usually endoscopic surgery) may be necessary to relieve pressure on the nerve.
Ganglions and Cysts
Ganglions are fluid-filled cysts commonly found on the tendons and joints of the wrists or hands. They may develop suddenly or over time and appear as a small, raised lump near your wrist or finger joints. While ganglions are usually benign and harmless, cysts may put pressure on nearby nerves, potentially causing pain, weakness or numbness.
The specific cause of ganglions is unknown, although they tend to occur in patients with osteoarthritis, and are most common in women between the ages of 25 and 45. They often occur spontaneously when the soft sheath around a tendon or joint swells and fills with mucus.
Despite the lack of complications associated with ganglion cysts, you should still seek medical attention if you notice a lump on your wrist or hand. Treatment is not always necessary, but many wish to have the cyst removed for cosmetic reasons or to relieve pain that has developed over time. Ganglions can be treated through a variety of methods, depending on the size and severity of the cyst. Some of these treatments include:
- Immobilization – Resting the wrist or wearing a splint can often release pressure on the nerves to relieve pain, and also decrease the size of the cyst.
- Aspiration – This minimally invasive procedure involves draining the fluid from the cyst with a syringe. Local anesthetic is applied and may be combined with a steroid injection to help fully heal the area. This treatment is not always permanent and many ganglions return after aspiration.
- Surgery – Surgery may be recommended for cysts that are very painful or interfere with joint movement. Ganglion surgery is performed under a local anesthetic and involves complete removal of the cyst and any attached tissue to ensure permanent treatment. Physical therapy may be recommended after surgery in order to rehabilitate the hand or wrist.
Your doctor can help you decide which treatment option is best for you.