Minimally invasive surgery for carpal tunnel syndrome
Are you experiencing numbness in your hands or wrists when doing the most basic things?
Minimally invasive surgery for carpal tunnel syndrome
If you have pain or struggle to perform simple daily tasks, or brush your teeth or drive your car, then you might be suffering from carpal tunnel syndrome.
The carpal tunnel is a small and narrow tunnel-like area inside your wrist where the median nerve travels. Running from your forearm to your hand, the median nerve controls the feeling in your palm, thumb, index and middle so you feel numbness if your nerve is compressed. The carpal tunnel protects this median nerve and nine other tendons. The syndrome occurs when there is compression to the median nerve, especially if it is squeezed or pressed onto the wrist. This can also occur from the swelling and inflammation of other minor tendons and synovium (joint lining) issues.
The compressed nature of the carpal tunnel and the median nerve affects movement and feeling in the palm of the hand or in the first three fingers. The most common symptoms are:
- Your fingers feel awkward, as if thickening or become dysfunctional
- Numbness and pain in the hand
- Constant tingling
- Pain travelling up the arm
- The strength of your grip worsens. Forming a fist becomes difficult as well as grasping little objects
- Weakness and cramping of the hand
These symptoms mostly occur during the night because most people sleep with a flexed wrist, which is the cause of over-compression. Some people awaken and need to shake the wrist, helps to lessen the numbness. Some have symptoms during brushing teeth or driving their car. It is a syndrome, which can either persist or resolve itself. In severe cases, patients’ muscles at the base of their thumbs can waste away. Holding and gripping becomes more difficult or almost impossible. Some lose their sense of touch entirely, even unable to distinguish between hot and cold.
Carpal tunnel syndrome is a result of the increased pressure on the median nerve that occurs from over tightness of transverse carpal ligament. While many suffer from carpal tunnel syndrome due to constant use of computer and texting, other common factors which can influence the development of the syndrome are:
- Repeated flexing of the wrists
- Other diseases like diabetes, rheumatoid arthritis or obesity
- Repetitive stress injuries
- A wrist fracture or dislocation
- Heredity
- Hormonal changes during pregnancy
- Menopause
- A cyst or tumour in the carpal tunnel
- Frequent use of vibrating hand tools
- Getting older: the syndrome is common among older age groups
- Gender: women tend to suffer from it more than men
In the past to relieve the nerve pressure, a standard carpal tunnel release treatment consisted of in-patient surgery with a long 3-5 cm wound incision. Because of the long incision and wide dissection, surgery had to be undertaken under adequate general or regional anaesthesia. The surgeries had wound complications such as wound dehiscence and painful scars. In 1988, minimally Invasive Surgery (MIS) was introduced as a way of reducing those complications and has become more widespread in hospitals around the world. In 2008, a new advanced technique, now widely known as the Wongsiri technique, and a special tool of Minimally Invasive Surgery (MIS) was introduced. This new technique had superior outcome over open standard carpal tunnel release. Because of keyhole incision, there is less injury to the body, most patients do not need general anaesthesia, do not need to stay in hospital, and experience early recovery in a few days at home with less wound pain. The special tool (a special thin visualisation tube and special micro knife) is passed through the area, and allows doctors to have a more specific view of the operating area and release specifically the overly tight transverse carpal ligament. The goal of advanced MIS is to achieve the high level of success of complete release surgery, with more benefits for the patient and less downtime.
The Wongsiri technique and the minimally invasive surgery is today a more appealing treatment option for carpal tunnel syndrome. The patient is first put under local anaesthesia; the surgeon then creates one small incision in the wrist. The specially designed visual tube is passed through and the surgeon then cuts the transverse carpal ligament inside the carpal tunnel, which causes compression on median nerve and the pain.
Minimally invasive surgery is the commonly preferred treatment for carpal tunnel syndrome due to the following reasons:
- The patient may experience less pain after MIS surgery than open surgery
- No hospital admission or general anaesthesia, thus reducing costs
- Scarring is minimised
- Less blood loss and complication
- Allows the patient to resume normal activities more quickly
Minimally invasive surgery allows for a smoother and faster recovery time for carpal tunnel syndrome patients. There might be some initial soreness or stiffness and some patients might be required to undergo physical therapy after the surgery to regain strength in the wrist. Possible complications include bleeding, nerve damage or infection. Your doctor is the best person to advise you on how to proceed, especially in regards to resuming your work or daily activities.
ASST PROF DR SUNTON WONGSIRI Is an Orthopaedic Surgeon |specialising in Hand and Microsurgery at Samitivej Sukhumvit Hospital. Call (02) 711 8494-6.
