PROS AND CONS OF CARPAL TUNNEL SURGERY

PROS AND CONS OF CARPAL TUNNEL SURGERY

The carpal tunnel is a narrow corridor at the base of the hand that contains tendons, ligaments, bones and the median nerve. Through this tunnel, there are 11 structures in total: four tendons of the common flexor superficial muscle of the fingers, four tendons of the common flexor muscle deep of the fingers of the hand, one tendon of the palmar major and one tendon of the flexor pollicis longus. It also houses the Median Nerve.

In Carpal Tunnel Syndrome, the tendons swell, and the median nerve is restricted, narrowing the tunnel; this causes numbness, discomfort or decreased control in the movements of the hand, wrist, and fingers. There are several activities in which there is great tension in the tendons of the wrist as is the case of violinists, pianists and frequent users of the computer mouse. If left unchecked Carpal Tunnel Syndrome is a condition that causes damage to the median nerve. If there is, for any reason, an increase in pressure within the carpal tunnel, an injury to that nerve can occur.

Initially, most patients complain of pain in the region of the wrist and forearm, associating sensation of tightening, cramping and tingling in the thumb, index, middle and part of the ring finger. These symptoms are typically nocturnal. Subsequently, if left untreated, there will appear a weakness and atrophy of some muscles of the hand, especially those controlling the thumb, as well as clumsiness when handling objects.

It is a very common pathology, being the most common neuropathy of peripheral nerve compression in the world. It affects 1-3% of the general population and more than 5% of workers in certain occupations that require repetitive use of hands and wrists. Carpal Tunnel Syndrome is seen much more frequently in women between the ages of forty to sixty years of age, being bilateral in more than 50% of cases.

Mild cases can progress favorably with treatment by immobilization of the wrist or with the injection of certain corticosteroids. In more advanced cases, a solution may be surgical, freeing the nerve trapped in the carpal tunnel.

Being diagnosed with a case of Carpal Tunnel Syndrome is never an agreeable piece of news, and many are left disoriented and overly concerned about their future well-being. Nowadays doctors eagerly resort to surgery as the only solution to eliminate this insidious malady. However, there are some serious risks involved, and in some cases, it is best to look for alternative solutions. It is not unheard of that in some cases the surgery is infective and puts the quality of life of the patient into question. Occasionally it has been seen that far from improving, the symptoms of this disease have worsened after a carpal tunnel operation.

Let us talk a little about how precisely a carpal tunnel surgery is performed and discuss the possible risks.

The surgery is carried out in the following manner:

• First, you receive anesthesia so that you do not feel pain during the surgery. You will remain awake, but will also receive medications to make you relax.
• A small surgical incision is made in the palm near the wrist.
• Then, the ligament covering the carpal tunnel is cut; this relieves the pressure on the median nerve. Sometimes, the tissue around the nerve is also removed.
• The skin and tissue are closed underneath it with sutures.
• Sometimes this procedure is carried out using a tiny camera attached to a monitor. The surgeon introduces the camera inside the wrist through a very small surgical incision and watches the monitor to see inside the wrist; this is called endoscopic surgery.
• This surgery is an outpatient procedure, so you will not need to be hospitalized.
• After the surgery, your wrist will be set with a splint or thick bandage for about a week.

What are the risks involved in this procedure?

The risks are many and should be carefully considered before making a decision to move forward with the operation. The main risk involved in this type of surgery is the possible damage to the median nerve. Due to the proximity of the nerves within the area of ​​the wrist, the possibility that the surgeon cut the wrong nerve is quite high. This mistake happens on a regular basis. If the transverse carpal ligament ruptures, the pain and numbness in the area may increase. Incorrect nerve rupture can often lead to complete paralysis of the area. Not being able to use your hand can be a terrible risk to take. With only a 50% success rate of patient satisfaction, this surgery might not be the best option for everybody.

Post-operative bleeding is another serious risk to consider. This type of bleeding can be difficult to control and lead to infection and other unnecessary ailments. If the bleeding is not controlled, the patient runs the risk of additional damage.

A permanent loss of grip strength is commonly associated with a Carpal Tunnel Syndrome surgery. Another common complaint that is heard from patients that have undergone this procedure is the heightened sensitivity of the scar tissue which over time grows to be a nuisance. One last thing to remember is that a surgical solution is that it may not be permanent and the need for a repeat procedure might arise in the future and with each subsequent surgery the risks are multiplied.

Are there benefits to undergoing carpal tunnel syndrome surgery?

Undoubtedly the release of the carpal tunnel decreases pain, tingling in the nerve and the sensation of numbness in the area as well as restoring muscle strength. Many people are relieved by this surgery. Many patients also often express an improvement to joint mobility. Carpal Tunnel Syndrome surgery is also relatively painless and has a quick recovery period.

Remember that surgery is not the only option; there are plenty of therapeutic and other noninvasive techniques that can perhaps offer you relief from the pain associated with carpal tunnel. Always consult with your doctor to find the best option for your specific conditions. The severity of your carpal tunnel syndrome will dictate to a large degree what the best course of action might be.

REFERENCES:

• Pätiälä, H., et al. “Carpal tunnel syndrome.” Archives of Orthopaedic and Trauma Surgery 104.2 (1985): 69-73.
• Gelberman, Richard H., et al. “The carpal tunnel syndrome. A study of carpal canal pressures.” JBJS 63.3 (1981): 380-383.
• MacDonald, Rodney I., et al. “Complications of surgical release for carpal tunnel syndrome.” The Journal of hand surgery 3.1 (1978): 70-76.

This article is not intended to replace the professional advice of a medical doctor. Please consult your doctor.

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