Surgery for carpal tunnel syndrome (CTS) can be extremely beneficial in enhancing the affected person’s quality of life. CTS is not a major health condition, but it has adverse effects in the short and long term. People who have early-stage carpal tunnel syndrome find the condition extremely annoying due to the persistent pain or tingling sensations. Treating this condition is important because in the long run, CTS can cause severe and permanent nerve and muscle damage.
Carpal tunnel surgery is recommended by doctors for patients who have not improved with other treatment methods or whose symptoms appear to be getting worse. The CTS surgery is a simple procedure that ensures relief from the condition. Before we get into the surgery, let’s first define carpal tunnel syndrome.
Carpal tunnel syndrome
CTS occurs when your median nerve is irritated or compressed, which is why this condition is also called median nerve compression. This median nerve is responsible for the motor and sensory functions of first three fingers and the thumb. People with CTS experience symptoms tingling, numbness, weakness, or pain in the connected fingers and thumbs of the affected hand.
The median nerve passes across the carpal tunnel, which is a tiny, one-inch-wide opening in the wrist. Carpal bones, which are tiny wrist bones, make up the tunnel’s floor and walls. The roof of the tunnel is made of connective tissue called the transverse carpal ligament. Different factors can cause an increase in the median nerve pressure, resulting in CTS. The important thing is to address this issue headfirst, so it does not progressively worsen and impede everyday activities.
Carpal tunnel syndrome symptoms
The symptoms of carpal tunnel syndrome appear gradually over time, starting with a slight tingling sensation in the thumbs and fingers and building up to the inability to properly perform basic daily tasks due to pain or weakness. Some common symptoms are:
- Tingling or sensation in the fingers
- Swollen fingers
- A feeling of needles and pins in the fingers
- Numbness or pain in the affected hand
- Weakness in the hands while gripping objects with the affected hand
Typically, the pain or discomfort in your fingers or hand will worsen throughout the day and disrupt your sleep at night. This is because we use our hands frequently throughout the day for routine tasks such as typing, cooking, and dishwashing. Sometimes, people also complain about experiencing these sensations traveling from the wrist up the arm.
Causes of CTS
CTS is a common hand ailment that can have a number of contributing factors, like:
- Activities that require frequent, repetitive, small, or grasping hand movements (such as typing some physical activities like driving)
- Joint disease like arthritis, osteoarthritis, rheumatoid arthritis
- Changes in the hormones or metabolism such as menopause, pregnancy, thyroid ailments
- Variations in the levels of blood sugar due to conditions like Type 2 diabetes
- Wrist injuries including sprain and dislocation
- Inflammation or swelling of the wrist
- History of this condition in a family
The symptoms of CTS may be like other medical conditions, so seeking medical advice is essential.
Diagnosing CTS
During consultation, your doctor will want to know your medical history, lifestyle, chosen profession, and whether there is a family history of CTS. They may also conduct one or more of the following tests to confirm the diagnosis and eliminate the possibility of other diseases:
Physical exam The doctor will test the sensory range of the fingers and the strength of muscles in the affected hand.
Ultrasound
An ultrasound can help identify the median nerve compression and give a good picture of the nerves and bones in the patient’s hand.
Electromyography
The physician will insert a needle-like thin electrode into specific muscles to evaluate the electric signals generated when muscles contract and rest. This procedure can help examine the damage caused by CTS to the median-connected muscles and eliminate other possibilities.
Nerve conduction study
This is a variation of electromyography in which two electrodes are taped to the skin and a small shock is passed through the median nerve. If the electrical impulses slow down in the carpal tunnel, it indicates that the person has carpal tunnel syndrome.
X-ray
An x-ray of the affected wrist is ordered by some doctors to eliminate the possibility of other causes such as a fracture, arthritis, or bone disease.
Risk factors of CTS
The following factors are associated with people developing carpal tunnel syndrome:
- A wrist injury or bone/joint diseases, such as arthritis, wrist dislocation, can modify the space in the carpal tunnel, thereby increasing the risk of CTS
- Women or people with small wrists are likely to develop CTS
- Obesity can also result in the carpal tunnel being crammed and cause CTS
- Changes in bodily fluid, such as fluid retention, may increase the pressure in the carpal tunnel along with increasing the risk of you getting CTS
- Working on an assembly line or with vibrating tools requires the person to perform small and repetitive tasks frequently, which increases the chance of CTS
Treatment for carpal tunnel syndrome
Carpal tunnel syndrome is a condition that progresses with passing time. Thus, early detection of the condition can aid you avoid any serious nerve or muscle damage associated with chronic carpal tunnel syndrome. Early-stage CTS can be treated with some adjustments to your lifestyle, for example:
- Taking frequent small breaks to rest the hands
- Avoiding repetitive and small actions with your hands that can worsen the condition (this might lead to a change in one’s profession if possible)
- Applying cold packs to the wrist area to reduce the swelling
If your condition has passed the early stage, your doctor might recommend these treatment options to improve your situation.
Wrist splinting
Splints are used to hold your wrist immobile during night to prevent you from waking up in the middle of the night due to pain or tingling sensation.
Medication
The doctor might recommend you take non-steroidal anti-inflammatory drugs (NSAIDs) orally to relieve pain in the short term. Another option involves injecting corticosteroids in the carpal tunnel to relieve pain; these injections reduce inflammation and swelling.
Another method of treating severe cases of CTS is carpal tunnel syndrome surgery, where manual intervention releases the excess pressure on the median. The doctor cuts the traverse carpal ligament passing over the median nerve to release the pressure in CTS surgery. This is why the carpal tunnel surgery is also known as CTS release surgery.
Who needs the carpal tunnel syndrome surgery?
If the patient doesn’t respond to any other treatment methods and has developed a severe case of CTS, then the doctor usually recommends surgery. Here are some of the cases where your doctor might recommend you have the CTS surgery:
- People who have persistent pain, tingling sensation, and numbness that hasn’t improved in the past 6 months or so
- People who have a hard time going about their lives and doing basic tasks such as gripping, grasping, or pinching objects
Immediate treatment for your condition is important because it does not improve on its own. Without treatment, you may also sustain permanent nerve and muscle damage.
Carpal tunnel syndrome surgery
There are two kinds of carpal tunnel surgery that are commonly used: open CTS surgery as well as endoscopic CTS surgery. Both surgeries work on the same principle of releasing pressure from the median nerve by cutting the transverse carpal ligament. Post-surgery, this heals and joins in the middle with more room for the median nerve.
Open carpal tunnel surgery
The surgeon creates an opening in the palm of the hand over the carpal tunnel with a scalpel. They then open the tissues and find the transverse carpal ligament. Using a sharp tool, they carefully cut through this ligament to free the nerve. The wound is then cleaned and stitched shut.
Endoscopic carpal tunnel surgery
This is a minimally invasive procedure that only requires a centimetre-long incision. After making the cut at your wrist, the surgeon cuts and opens the tissue. Dilators are used to release the carpal tunnel to make room for the tray for endoscopy. This tray resembles a thick metallic straw cut in half.
The surgeon then uses the camera attached to a thin tube with light to examine the carpal tunnel. Using another tube-like structure with a knife at the end, inserted through the tray, they will cut the transverse carpal ligament. They then double-check that everything is in order before proceeding to close the stitch.
Benefits of carpal tunnel syndrome surgery
The surgery can help improve the overall quality of a person’s life as carpal tunnel syndrome can cause excruciating pain. People with CTS find everyday activities such as holding a mug or opening the lock quite challenging. They can improve their dexterity and the functioning of the hand.
The carpal tunnel surgery relieves the constant pressure on the median nerve and prevents the condition from causing permanent nerve and muscle damage.
What are the risks involved with the carpal tunnel syndrome surgery?
There are a few risks associated with the CTS surgery, just like any other surgery, including the following:
- Allergic reaction to general/local anaesthesia
- Excessive bleeding for some people
- Infection
- Damage to the median or other nerves branching from it
- Damage to the nearby blood vessels
- A sensitive scar
There may be other risks involved with the surgery, depending on your medical history. To minimise surgery risks, it is important to inform your doctor about your past and current health problems.
Preparation for the carpal tunnel syndrome surgery
It is important to inform your doctor about any medication you are currently taking, including dietary supplements, natural or Ayurvedic medications, and over-the-counter drugs. The doctor will also recommend some blood tests or an electrocardiogram (ECG) before the surgery as part of the standard protocol.
You will be asked to pause certain medications and stop smoking to facilitate a quicker healing time. The surgery requires you to fast for 6–12 hours before to avoid any complications.
Recovery process and rehabilitation after the carpal tunnel syndrome surgery
After the surgery, your wrist will be encased in a heavy bandage for about 1-2 days in the case of an endoscopic surgery and about 1-2 weeks if you have an open surgery. The doctor may also prescribe some pain-relieving medicines during this time. Later on, you will likely get a clean dressing done and be asked to wear a brace on the wrist. Stitches usually come out in 7 to 10 days during the healing process.
People are encouraged to explore a subtle range of motion initially and gradually build their strength over the course of a month. After about 8 weeks you will be able to perform almost every activity related to day-to-day living. You will likely need more time to build adequate strength to restart strenuous exercises or sports.
Carpal tunnel syndrome surgery cost
The carpal tunnel surgery costs depend on various factors, including the following:
- Type of surgery (open or endoscopic)
- Expertise of the surgeon
- Hospital and other services
- Pre-existing diseases including highly infectious diseases
- City or location
On average, the CTS surgery costs in India are about INR 60,000 to 70,000. The prices for this surgery can range from as low as INR 30,000 to INR 3,75,000 approximately.
Government hospitals offer an inexpensive alternative for carpal tunnel surgery in comparison to private hospitals, but the services provided vary greatly and it is extremely difficult to get an appointment.
Summary
Carpal tunnel syndrome is a common condition that people suffer from nowadays, possibly because of their increasingly digital lifestyle. . The condition can be debilitating for people and prevent them from having a wholesome life.
We use our hands for countless things during the day without noticing. Even seemingly insignificant hand movements, such as holding a teacup or driving a car, can be the cause of extreme pain. Going through carpal tunnel surgery can greatly improve your overall experience.
You are recommended to consult with your doctor about all the possible treatment options and choose the one that is most suitable for you. Some people with mild to moderate symptoms can benefit from non-surgical treatments, including lifestyle changes and medication. Others with severe symptoms will require the CTS surgery to get back to their normal lives.
