CARPAL TUNNEL SYNDROME
- What is carpal tunnel syndrome?
- What Causes Carpal Tunnel Pain?
- How is Carpal Tunnel Diagnosed?
- Treatment : Conservative Vs Surgical
- Traditional nonsurgical (TEMPORARY) treatment options
- 1. Splinting
- 2. Cortisone infiltration
- 3. Physiotherapy, occupational therapy
- Carpal Tunnel Surgery
- 1. Open carpal tunnel release
- 2. Endoscopic release (ECTR)
- Benefits of ECTR
What is carpal tunnel syndrome?
Carpal tunnel syndrome is the single most common cause of hand pain in the world affecting millions of people. What most people don’t know is that it is also incredibly simple to cure.
Carpal Tunnel syndrome is a pain and discomfort in the hand and fingers usually caused by inflammation of the median nerve in the wrist. The median nerve passes through the Carpel Tunnel in the wrist so if the passage is restricted or the nerve is swollen, a problem will occur. There are many possible reasons for the swelling of the median nerve or restriction of the Carpel Tunnel. A proper diagnosis of the problem is always the first step in treating the issue.
If you have weakness in the wrist, numbness and tingling in the fingers, or other problems associated with using your hand, the probable cause is Carpal Tunnel Syndrome.
Symptoms in your thumb, index, middle, and ring finger but not your little finger, are a good indication that you have Carpal Tunnel Syndrome since a different nerve gives feeling to the little finger.
The Pain and discomfort of carpal tunnel syndrome typically wakes you up at night. It can also cause you to lose feeling in your hands and also causes hand pain and weakness during the day, preventing so many people from performing daily activities in a comfortable way. It has always amazed me how many people think that this is a normal part of growing old, and so they don’t talk about it and they put up with this gradually worsening inconvenience.
I have been a fellowship trained board-certified hand surgeon for the past 25 years and I can tell you that this pain CAN be cured very simply and you can be rid of the discomfort in your hands and go on with your daily life pain-free very simply.
I have helped thousands of patients suffering from hand pain and carpal tunnel syndrome. I offer them relief from pain, increased hand mobility and help them go on to live happy productive pain-free life.
In order to cure your carpal tunnel syndrome pain, you must first realize that having a painful numb hand that wake you up at night is not a normal part of life, and that it is curable ! The second step involves understanding what is causing your pain.
What Causes Carpal Tunnel Pain?
Carpal tunnel syndrome is not something that has happened to you and it is not something that you have done wrong. It is unfortunately a natural part of the body‘s growing process whereby a nerve in the wrist becomes compressed due to natural factors.
The Carpal Tunnel is a small space in the wrist where nine tendons and one nerve cross through in order to get to your hand. This space is small and quite fixed. The tendons are tough, rope-like strands which lead to the fingers, whereas the nerve in this tight space is soft, spongy, and is the only structure sensitive to the effects of increased pressure.
Throughout life, and our activities, our bodily tissues can get swollen. When swelling occurs inside this small tunnel, the nerve is the first to be adversely affected; and this abnormal pressure on the nerve causes numbness, tingling, and pain in the hand which affects daily activities, and often will also wake you up at night.
As I have already mentioned this is the single most common cause of pain in the hands during a person’s life.
How is Carpal Tunnel Diagnosed?
Carpal Tunnel Syndrome is diagnosed when a medical professional listens to your symptoms, and does a clinical physical examination of the your hand function including sensory and motor testing. As with most things in medicine, it is not advisable (nor for that matter possible) to diagnose a carpal tunnel compression (or any other medical condition) over the phone or by way of an “internet consultation”. A proper history and physical examination by a certified hand surgeon is the single best way to isolate this problem from other similar (less frequent) diagnoses. And once this condition has occurred and is properly recognized: it is easily treatable.
Conservative Vs Surgical
Many treatments have been offered in the past for carpal tunnel syndrome. These treatments can range from applying splints, to providing Cortisone infiltrations into the wrist, to embarking on an arduous physical therapy program.
But and here is the key: all these treatments for carpal tunnel syndrome will only work TEMPORARILY. The reason most non surgical treatments for carpal tunnel syndrome only work partially and temporarily is because of this: eventually this pinched nerve (the median nerve), will become so pinched that not only the nerve fibers will be dangerously compressed, but the circulation to the nerve will be interrupted and stopped.
Without circulation, the nerve will slowly begin to die. And the only way to restore circulation to the nerve and thus get rid of this carpal tunnel pain, and restore function is by taking the pressure off of the nerve with a very short simple surgical procedure that creates room for the nerve to live in without being compressed.
So, once you know that you have carpal tunnel syndrome, you can either choose to undergo inconvenient re-current temporary treatments that will never really cure the cause of your pain; or you can choose to address the cause (the compression of this nerve) with a very simple and easy to perform short surgical procedure (which I perform in less than 5 minutes) that will allow you to remain pain-free for the rest of your life.
1. Splinting at night and during the day
The goal of splinting theoretically is to place the wrist and the nerve in a position to maximize blood flow. This will provide partial and temporary relief of the pain associated with carpal tunnel syndrome. Because actually nothing is done to relieve the pressure on the nerve or the compression that the nerve is subject to and the compression that the blood vessels around the nerves are also subjected to. Eventually pressure on the nerve and will continue to worsen such that splinting and it’s inconvenience will fail in 100% of patients.
2. Cortisone infiltration into the wrist
This is the most dangerous form of treatment available for carpal tunnel syndrome. It was one thought that Cortisone, a medication known to reduce swelling of human tissue, may lead to less compression of the nerve by decreasing the swelling in the carpal tunnel. So far so good. But the problem is this; anyone who injects a needle into your wrist may inadvertently hit the nerve with that needle and the damage caused will now become permanent and irreversible. It is for this reason that for the past 20 years Canadian and American societies for hand surgery have strongly discouraged Cortisone infiltration for carpal tunnel relief. Even if you were lucky and the needle does not touch your nerve, the Cortisone that is deposited into the carpal tunnel will have a limited time benefit to reduce the swelling around the nerve in such patients and initial period of. Relief will be short-lived, because once the medication has been absorbed and metabolized the natural swelling within the carpal Tunnel will resume as will the compression of the nerve and it’s vessels. The Cortisone of infiltration is at best a temporary relief measure, and at worst a dangerous form of treatment that can lead to permanent paralysis.
3. Physiotherapy, occupational therapy, or other type of hand exercises
The goal of exercises is to manually pump and promote blood flow along the nerve. Theoretically this is a good thing. In actual fact the localize trauma caused by the exercising will increase the swelling in the nerve, which will once again because of the swelling it will become compressed and so will the blood vessels. The bottom line exercises may provide short-term relief, but over the long term the same exercises will increase the severity of nerve compression and therefore will also increase the severity of the symptoms associated with carpal tunnel syndrome.
It simply makes sense to release the pressure on the nerve?
The answer is: absolutely !
When A nerve is compressed or crushed anywhere in the body causing pain, the best way to relieve that pain is to take the pressure off the nerve.
This is true whether you have a pinched nerve in your neck, in your arm, in your back or in the case of carpal tunnel syndrome in your wrist.
Different Types of Carpal Tunnel Surgery
The goal in all Carpal Tunnel Surgeries is to relieve the pressure on the nerve.
How is this done?
This is achieved by surgically relieving the pressure off of the nerve, and creating room for the nerve to live without further compression.
Sounds simple doesn’t it? But not all surgical procedures are alike.
There are several ways to do surgery to relieve pressure in the carpal tunnel and on the nerve, which is a good thing. These different techniques boil down to one of two categories:
- OPEN APPROACH.
- MINIMALLY INVASIVE ENDOSCOPIC APPROACH.
And here is the difference between these two techniques !
1. Open carpal tunnel release
In this surgery, a 3 to 5 cm incision is made at the bottom part of the palm and five layers of tissue must be cut in order to access and decompress the nerve.
On the way to the carpal tunnel :
- the skin is opened,
- then the subcutaneous tissue is cut and separated,
- the aponeurosis of the hand is cut open,
- the muscles of the palm are transected,
- finally the ligament forming the roof of the carpal tunnel is released.
2. Endoscopic carpal tunnel release (ECTR)
In this surgery a less than 1 cm incision is made at the palm, and only ONE other structure is cut with the aid of a very small camera connected to a television.
This is called a MINIMALLY INVASIVE surgery because we achieve the same effect (of relieving the pressure on the nerve) but with minimal damage to all the other tissues of the hand.
The end result is that by avoiding the longer incision, and by not cutting and damaging the other structures in the hand, patients experience significantly less pot-op pain and heal up to FOUR TIMES FASTER !
Patients who have had endoscopic carpal tunnel surgery typically return to daily activities within 10 days : compared to open technique patients which are much more uncomfortable after surgery and can take up to 12->15 weeks of healing.
The next question is a simple one: Why don’t all surgeons offer ECTR?
The answer is quite simple. Firstly : this endoscopic technique represents the finest, most skilled approach that takes special training to master, and secondly : specialized instruments and cameras and monitors are required that not all institutions, administrators, or surgeons are ready to invest in.
But Dr Durand’s belief is unshakable. Only the best is good enough for my patients., and that is why I have been practicing this technique on satisfied patients for over 25 years !
Take Home Message:
When you take into consideration all the medical and surgical experience in the scientific literature regarding the treatment of carpal tunnel syndrome, there is absolutely no doubt that Minimally Invasive Endoscopic Carpal Tunnel Release Surgery is the single and best method that provides long-term lifelong pain relief from carpel tunnel syndrome.
Benefits of ECTR
1. IMMEDIATE relief of the most painful symptoms associated with carpal tunnel syndrome. Most patients describe instantaneous relief of their pain within the first 24 hrs after treatment.
2. EFFICIENT and rapid return to work, and regular daily pain-free activities and living.
3. FAST efficient minimally invasive endoscopic surgical technique perfected by Dr. DURAND over the past 25 years! Average technique lasts less than 5 minutes !
4. LIFELONG symptomatic relief of pain.
Dr DURAND is the only fellowship trained hand surgeon, Board Certified in Canada and the United States, with 25 years of hand surgery experience, and is a former associate professor at McGill University, and former Examiner for Royal College of Physicians and Surgeons of Canada.
Dr Durand also has a Masters degree in Experimental Nerve surgery from McGill University, and thus is uniquely suited to bring you the the best and most highly tuned treatment to the condition of carpal tunnel syndrome, as well as all aspects of hand surgery.
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Treatments OFTEN available SAME DAY or within 1week !