HCA North Florida Division - February 13, 2018

Have you woken up from sleep with numbness, burning, or pins & needles sensations in your hands? Do you notice that you are dropping items often, your sense of touch or your grip is weakening? Are you having pain or difficulty with fine motors skills like writing, fastening buttons or sewing? If you answered “yes” to any of those questions, you may have carpal tunnel syndrome (CTS). CTS is an entrapment neuropathy, meaning the compression of a nerve to the point of disrupting the normal electrical signals that pass through it. In CTS, the median nerve in your wrist is affected. When irritated, the nerve creates symptoms of pain, numbness, or weakness usually in the thumb, index, middle, and ring fingers. Common activities (e.g., talking on the phone, holding a book, or driving) tend to bring on the symptoms.

The cause of carpal tunnel syndrome cannot be accurately determined in most cases. Both hands are affected in about 50% of patients. Each year in the USA, over 400,000 CTS surgeries take place.

To diagnose CTS, your physician will ask about your symptoms and perform an examination of your hand, wrist, arm, and neck. During the exam, your CTS symptoms are often created. Your medical history and physical lead to an accurate diagnosis over 80% of the time. However, special testing of the nerve can aid in diagnosis. Electro-Diagnostic tests can be performed to determine what nerve(s), which locations, and how severe the disease is.

Here are the answers to common questions about how CTS is treated:

  • What are the first steps a doctor will take?
    Splint use at bedtime is usually the first course of treatment if your symptoms mainly affect you overnight. If related to hand use, I’d advise to taking frequent breaks during repetitive tasks, or if possible, stopping activities that create the symptoms.
  • Are medications helpful?
    Non-steroidal anti-inflammatories (NSAIDs), such as naproxen or ibuprofen, may alleviate pain and symptoms of early CTS. However, they have potential side effects with long term use. A steroid or cortisone injection in the office can relieve all or most of your symptoms.
  • When should surgery be considered?
    When less invasive treatments haven’t worked, surgery is the most effective and successful long-term treatment.
  • What will the surgery be like?
    I perform CTS surgery as an outpatient procedure. The patient can choose to have just local anesthesia or to be put to sleep so they don’t remember the event. The surgery can be done with a traditional open incision on the palm, or a less invasive endoscopic technique.
  • What is Endoscopic Surgery?
    This newer, less invasive method, uses a special video camera to view inside the hand. With a 1-2cm incision on the wrist, the endoscope camera enters the carpal tunnel. Under direct visualization, a small blade on the scope releases the structure compressing the nerve. Recent studies show less complications after endoscopic surgery.
  • Is recovery faster with Endoscopic surgery?
    With endoscopic surgery, I only use 1or 2 stitches on the inside of your wrist compared with 4-8 on the palm during traditional open surgery. The endoscopic recovery is faster and patients more functional sooner because the traditional incision on the palm is painful, and limits hand use for 3-4 weeks. You can immediately begin light activities like eating or getting dressed the day of surgery, and most patients can drive a car the next day. Pretty much, if it doesn’t hurt, it’s okay to do.
  • What’s the long-term prognosis?
    In most patients, the tingling and pain of CTS usually vanishes quickly after surgery. For more advanced disease, the nerve healing after surgery can take weeks. In the most severe cases, involving permanent nerve damage, complete resolution of symptoms is uncommon. Overall, carpal tunnel release surgery has very high patient satisfaction rate.

Dr. Pasquale Reino is a credentialed Orthopedic Surgeon at Poinciana Medical Center. To learn more about Dr. Reino, search "Reino" on PoincianaMedicalCenter.com's "Find a Doctor" page or call 888-253-8117