Hello, my name is Dr. Alexander Anzarut. I’m a plastic surgeon and a hand surgeon. After completing my residency in plastic surgery at the University of Alberta, I completed a hand surgery fellowship at the University of Pittsburgh. This video is designed to help you understand about carpal tunnel syndrome, what this condition is, what the treatment options are and what to expect if you have treatment for carpal tunnel syndrome. I advise you to watch the video before your appointment; that way, you can be best prepared for the consultation.
What is Carpal Tunnel Syndrome?
Inside the wrist, there is a space - a tunnel or a pipe - that we call the carpal tunnel. Inside that tunnel are nine tendons. These nine tendons, I have just outlined in blue. With use and with age, the nine tendons thicken. As they thicken, there is more stuff or more volume inside the tunnel. As a result, the pressure inside the tunnel increases. The only other thing inside the tunnel is a nerve known as the Median nerve. As the pressure in the tunnel increases, the nerve is compressed, and the nerve is starved of oxygen, leading to carpal tunnel syndrome.
Initially, patients may wake with symptoms of numbness and tingling and discomfort in the hand. As the condition progresses, one may have numbness and tingling in the hand that occurs in the daytime. It usually involves the area of the thumb, the index finger or pointer finger, the long finger, and the ringer finger. Initially, this numbness and tingling is intermittent, however, as the condition progresses, it becomes more common and eventually may become constant. Once the nerve is constantly starved of oxygen due to the high pressure in the carpal tunnel, parts of the nerve can die off. As a result, patients may end up with permanent numbness and tingling that cannot be reversed.
Who Should Consider Carpal Tunnel Surgery?
In this segment, I would like to discuss the indications for carpal tunnel surgery. In general, patients who have constant numbness or tingling should undergo carpal tunnel surgery to avoid permanent damage to the hand. Patients who have thumb muscle weakness due to carpal tunnel syndrome should have carpal tunnel surgery to avoid further permanent damage to the hand. The type of thumb muscle weakness caused by carpal tunnel syndrome is often seen as wasting or slimming of the muscle in this area. Patients will also often have trouble doing this motion with the thumb - moving the thumb away from the palm. Many people without these symptoms will also choose to go through carpal tunnel surgery in order to avoid worsening of their symptoms and protect the nerve or because the carpal tunnel syndrome for them is impairing their ability to work or to have a satisfying quality of life.
What is Carpal Tunnel Release Surgery?
Surgical treatment of carpal tunnel involves decreasing the pressure inside the carpal tunnel. This circle that I’m outlining in blue represents the carpal tunnel. Surgery is quite straightforward for myself, the surgeon. It is done under local anesthetic and takes approximately five to 10 minutes.
An incision is made at the roof of the tunnel. As a result, the tunnel opens and enlarges, leading to decreased pressure in the nerve and a healthier nerve. Over time, the tunnel scars closed, however, it stays enlarged and carpal tunnel syndrome should not return.
The carpal tunnel itself is located in the palm. This diagram shows the location of the roof of the carpal tunnel. The second diagram is a closeup of the roof of the carpal tunnel. This is also known as the transverse carpal ligament. The Median nerve or the nerve that is compressed in carpal tunnel syndrome runs in the tunnel underneath the roof of the tunnel, or underneath the transverse carpal ligament.
The goal of carpal tunnel surgery is to release or open the top of the tunnel without injury to the nerve. An incision is made in the palm from here to here through the skin. Once through the skin, an incision is made to release the transverse carpal ligament. Once this is done, the carpal tunnel release is complete, and the skin is sutured closed.
Learn more about carpal tunnel surgery here: dranzarut.com/body/carpal-tun...