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Description - Video - After Surgery When visiting a hand surgeon, the first step would be examination of the hands and a review of the symptoms. If CTS is suspected, depending on the severity and the situation, the surgeon may first prescribe non-operative treatment with splinting and anti-inflammatory drugs. Nerve conduction tests will positively determine the level of compression, if any. If symptoms resolve with non-surgical interventions, surgery can frequently be avoided. If not, then the "carpal tunnel release" surgery is recommended. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and likely will come to surgical treatment. In carpal tunnel release surgery, the goal is to divide the transverse carpal ligament in two. This is a wide ligament that runs across the hand, from the base of the thumb to the base of the fifth finger. It also forms the top of the carpal tunnel, and when the surgeon cuts across it (i.e., in a line with the middle finger) it no longer presses down on the nerves inside, relieving the pressure. There are several carpal tunnel release surgery variations: each surgeon has differences of preference based on their personal beliefs and experience. All techniques have several things in common, involving brief outpatient procedures; palm or wrist incision(s); and cutting of the transverse carpal ligament. The two major types of surgery are open-hand surgery and endoscopic surgery. Most surgeons perform open surgery, widely considered to be the gold standard. However, many surgeons are now performing endoscopic techniques. Open surgery involves a small incision somewhere on the palm about an inch or two in length. Through this the ligament can be directly visualized and divided with relative safety. Endoscopic techniques involve one or two smaller incisions (less than half inch each) through which instrumentation is introduced including probes, knives and the scope used to visualize the operative field. All of the surgical options typically have relatively rapid recovery profiles (days to weeks depending on the activity and technique), and all usually leave a cosmetically insignificant scar. Surgery to correct carpal tunnel syndrome has a 90% or higher success rate, especially using endoscopic surgery techniques. In general, endoscopic techniques are as effective as traditional open carpal surgeries, though the faster recovery time typically noted in endoscopic procedures may be offset by higher complication rates. Success is greatest in patients with the most typical symptoms. The most common cause of failure is incorrect diagnosis, and it should be noted that this surgery will only fix carpal tunnel syndrome, and will not relieve symptoms with alternate causes. Recurrence is rare, and apparent recurrence usually results from a misdiagnosis of another problem. Complications can occur, but serious ones are infrequent to rare. Carpal tunnel surgery is usually performed by a hand surgeon, orthopaedic or plastic surgeon; some neurosurgeons and general surgeons also perform the procedure. Most people who find relief of their carpal tunnel symptoms with conservative or surgical management find minimal residual or "nerve damage". Long-term chronic carpal tunnel syndrome (typically seen in the elderly) can result in permanent "nerve damage", i.e. symptoms of numbness, muscle wasting and weakness. While outcomes are generally good, certain factors can contribute to poorer results that have little to do with nerves, anatomy, or surgery type. One study showed that mental status parameters, alcohol use, yield much poorer overall results of treatment. Many mild carpal tunnel syndrome sufferers either change their hand use pattern or posture at work or find a conservative, non-surgical treatment that allows them to return to full activity without hand numbness or pain, and without sleep disruption. Other people end up prioritizing their activities and possibly avoiding certain hand activities so that they can minimize pain and perform the essential tasks. Changing jobs is also commonly done to avoid continued repetitive stress tasks. Others find success by adjusting their repetitive movements, the frequency with which they do the movements, and the amount of time they rest between periods of performing the movements. While recurrence after surgery is a possibility, true recurrences are uncommon to rare. Such recurrence can also be non-CTS hand pain. Such hand pain may have existed prior to the surgery, which is one reason it is very important to get a proper diagnosis.
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