Your Carpal Tunnel Options
Hand surgery is a significant part of plastic surgery training. Hand related problems are treated by two kinds of doctors: Orthopedic Surgeons and Plastic Surgeons. Dr. Fichadia received comprehensive training in hand surgery during her plastic surgery residency at Oregon Health and Science University, and is proud to offer surgery to treat diseases that cause pain and impair the strength, function and flexibility of your hand and fingers.
Carpal tunnel syndrome is a characteristic combination of symptoms, with or without physical findings, which are believed to result from a problem with one of the major nerves to the hand (the median nerve) located at the anatomical site known as the carpal tunnel, which lies at the heel of the hand. The tunnel is the gap between the bones of the wrist and the transverse carpal ligament – a fibrous band. Nerve injury occurs from raised pressure in the carpal tunnel.
The most characteristic symptoms are tingling and numbness in the thumb, index and middle fingers which tend to wake patients up at night. Anyone who experiences this regularly should consider the possibility that they may have carpal tunnel syndrome. The diagnosis is usually made from the description of the symptoms and confirmatory tests are available as well. In the later stages, symptoms become constant rather than intermittent and eventually there is weakness and wasting of the muscles at the base of the thumb.
Initial treatment includes splinting, oral or injectable anti-inflammatory medications.
For patients who have persistent or progressive symptoms, surgical release is indicated. The surgery can be done using an open or endoscopic approach.
Open carpal tunnel release is done through an incision about one inch long in the palm of your hand near the wrist. If you are having an endoscopic carpal tunnel release, you may have a 0.5 inch incision near the wrist crease. It should be noted that if you’re having an endoscopic carpal tunnel release, Dr Fichadia would always reserve the right to convert this to an open procedure if she feels that this needs to be done for safety issues based upon your anatomy. The advantages and disadvantages to open versus endoscopic carpal tunnel release will be discussed at your visit.
The transverse carpal ligament that is the roof of the carpal tunnel is then cut. Once this ligament is cut, the space in the carpal tunnel is increased and the nerve is less likely to be constricted by surrounding structures. After surgery, the pain associated with the tingling and nighttime awakenings go away rather quickly. The numbness takes longer to resolve, and depending on its severity, may not resolve completely.
The operation is performed on an outpatient basis in the hospital or at an ambulatory surgical center. Various types of sedative and local anesthetics are used according to your surgeon’s and anesthesiologist’s preference to make you relaxed and comfortable during the operation. Skin sutures are used to close the wound and a soft dressing is applied to the hand. The procedure generally takes no more than 20 minutes. After surgery, you can move the fingers and thumb freely. Detailed post-operative instructions on hand exercises are given at the time of surgery. While patients should avoid heaving lifting for 4 weeks following the surgery, most patients are free to return to work as early as a few days after the operation if they have a job that permits it, and if their pain is well controlled. In general, patients return to work earlier after an endoscopic carpal tunnel release compared to open carpal tunnel release.
If you are struggling with carpal tunnel syndrome in the Portland area, contact Dr. Fichadia, a double-board certified plastic surgeon in Portland for more information or to schedule a consultation!