The carpal tunnel is a space formed by wrist bones (carpal bones) and a wrist-supporting ligament that sits on top of the bones (transverse carpal ligament).

• Carpal tunnel syndrome (CTS) develops when the median nerve, which runs inside the carpal tunnel, becomes compressed.
• This pressure can lead to numbness, tingling, pain and other symptoms in the hand and forearm.

Surgical procedures to treat carpal tunnel syndrome include:

• An open carpal tunnel release involves making an incision in the palm of the hand and cutting the transverse carpal ligament. This releases the pressure on the median nerve.
• Endoscopic carpal tunnel release involves making a tiny incision in your wrist. A small tool with a camera on the end is used to cut the transverse carpal ligament.

The costs associated with this care path are for an open carpal tunnel release.

CTS can be caused by any condition that increases the pressure on the carpal tunnel and median nerve. This includes:

• Having a smaller than normal carpal tunnel
• Being a female (women have a higher risk)
• Being older (risk increases as we age)
• Inflammatory conditions - such as rheumatoid arthritis, gout or tendonitis
• Wrist joint injuries
• Noncancerous tumors of the wrist
• Thyroid disease, hyperactive pituitary, diabetes and obesity
• Swelling related to conditions such as heart failure or pregnancy
• Occupations that involve repetitive motion of the hands and wrists

In some cases, no specific cause can be identified.

Contact your healthcare provider if you have symptoms of CTS. They will ask about your health history, current symptoms, work activities and hobbies. A physical exam may include a variety of simple tests to determine the degree of irritation of the median nerve. These tests include:

• Tapping the inside of your wrist
• Asking you to hold your wrist in a downward bent position for about a minute
• Gently pricking your hand or fingers and fingertips to determine sensation
• Checking for any loss of muscle strength and shape

Your healthcare provider may also recommend electromyography, nerve conduction studies, imaging studies and blood tests to determine if a specific condition is responsible for your symptoms.

The symptoms of CTS may resolve on their own, especially if you are young. Initial treatment (also called conservative or non-surgical treatment) for mild to moderate symptoms of CTS may include:

• Resting your affected wrist and hand and using the other hand when possible
• Avoiding activities that require repetitive twisting and turning of your wrist
• Elevating and icing your wrist
• Wearing a splint
• Physical therapy and cortisone injections

If an underlying illness such as a thyroid condition, diabetes or arthritis is causing your symptoms, treatment should first focus on the underlying illness. This may resolve your CTS symptoms. However, your healthcare provider may recommend a carpal tunnel release if you have:

• Severe nerve involvement or your symptoms are severe
• Symptoms that last longer than six months
• Symptoms that do not respond to conservative treatment

Prior to the procedure, tell your healthcare provider about any medications you are taking (including over the counter medications and supplements). Ask about specific instructions you should follow before surgery. These may include:

• Medications you should not take before the procedure, such as blood thinners
• Regular medications you should continue to take on the day of your procedure
• How many hours you should stop eating and drinking before the procedure

A carpal tunnel release is often done by an orthopedic surgeon in an outpatient facility.

• Typically, a local anesthetic is used to numb your wrist and hand.
• After surgery, physical therapy is common to increase the strength and mobility of your wrist.

Contact your healthcare provider if you have symptoms of carpal tunnel syndrome. Be prepared to discuss your symptoms and how long you've had them.

• Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
• Make a list of your medications (including over-the-counter).
• Write down any questions, symptoms or concerns you want to talk about.
• If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).

What should I ask my healthcare provider before having a carpal tunnel release?

• What is causing my condition and what are my treatment options?
• What are the benefits and risks of each treatment option?
• What can I do to prevent carpal tunnel syndrome or improve my symptoms?
• What are the possible complications for this surgery?
• What happens if I do not go through with the surgery?
• What is your experience in doing this type of surgery? What is your complication rate?
• Is there any special preparation for the surgery? (If so, get clear instructions on what you need to do.)
• Will I need anesthesia? What are the possible side effects?
• How will I feel after the surgery? Will I have to modify my activity?

After your surgery, you should know what you had done, what medication was given and what symptoms you should report to your healthcare provider after discharge. You should also understand all home care instructions (including medications and side effects) and follow-up plans.

• Your surgeon should also communicate with your primary care physician.
• Do not forget to arrange for transportation to and from the facility and help at home.

Source UHC.com

Also known as:

Wrist Surgery

Transverse Carpal Ligament

Release of Median Nerve

Release of Carpal Tunnel

Median Nerve

CTS

Carpal Tunnel Syndrome

Carpal Tunnel Surgery

Carpal Tunnel Release