Carpal Tunnel Surgery Options
The following are the 4 main procedures most commonly used to treat carpal tunnel syndrome:
Open Carpal Tunnel Release – Traditional carpal tunnel surgery with a large incision and longer recovery time.
Mini Carpal Tunnel Release – Similar to the traditional carpal tunnel surgery but with a smaller incision.
Endoscopic Carpal Tunnel Release – Video guided release through an open incision.
Minimally Invasive Endoscopic No Stitch Carpal Tunnel Release
OUR ENDOSCOPIC NO STITCH PROCEDURE
- Stitchless, minimally invasive procedure
- Outpatient procedure takes 10 minutes
- Minimal recovery time
- 98% surgical success rate
The minimally invasive endoscopic carpal tunnel release, also known as the No Stitch procedure, is the procedure of choice at the Hand Surgery Specialists of Texas for treating patients with carpal tunnel syndrome. This is a minimally invasive endoscopic carpal tunnel surgical procedure; it takes less than 10 minutes, can be done as a same-day procedure, and no stitches are required. Recovery is fast.
This procedure has a 98% success rate. Night time pain will be gone by the evening of surgery, while numbness and tingling will improve over time in an average of 3 months depending on the severity of the carpal tunnel syndrome.
Not all patients with carpal tunnel syndrome can have an endoscopic no stitch carpal tunnel release. The most common reasons are those with previous carpal tunnel surgery and abnormal anatomy (discovered during surgery). If that is the case, our hand surgeons will perform a traditional open procedure. The chance of this occurring is less than 0.5%.
Diagnosis of Carpal Tunnel Syndrome
Carpal tunnel syndrome is diagnosed based on patient history, physical examination, and additional tests. An individual with carpal tunnel syndrome may not have the same history, physical findings, or test result. A syndrome requires a hand specialist to put pieces of each of these three components together to make a diagnosis.
There are certain physical tests that can be used to aid in the diagnosis of carpal tunnel syndrome:
- Tinel’s test – tapping over the median nerve and eliciting a tingling or shock in the fingers.
- Carpal Tunnel Compression Test – holding pressure on the median nerve causing increased paresthesias to the fingers associated with the median nerve.
- Phalen’s Test – flexing the wrist at 90 degrees, thus reproducing paresthesias of the fingers.
Electromyelogram/Nerve Conduction Velocity (EMG/NCV) is the best test for objectively helping diagnose carpal tunnel syndrome. However, 5-15% of EMG/NCV can be normal, yet a patient can have carpal tunnel syndrome. There are a number of reasons that could explain this, but most likely is that there is pressure on the nerve in the carpal tunnel, but no nerve damage. EMG/NCV are operator dependent and there is inherent variability/subjectivity – not all physicians properly perform this exam. For example, one common mistake is that the hands are not warmed prior to study.
Post Surgery Hand Care
Keep dressings clean and dry. The dressings come off in 7-8 days after surgery and should be removed by the physician, unless otherwise instructed.Minimally Invasive Endoscopic No Stitch Carpal Tunnel Release
There are steri-strips covering the wound. The tape over the incision sites will come off when ready or may be removed with the splint and dressing. You may shower with a bag protecting the bandages, arm elevated in the air. Once the bandages come off, you may shower or wash hands. Avoid submerging hand in water such as bathing, swimming or doing dishes for 2 weeks after surgery. Avoid fishing for 3 weeks.
After 2 weeks, you may soak your hands in warm water with a scoop of epsom salts for 10 minutes daily in am (when you wake up) and 10 minutes in the pm (before sleep). This will help with inflammation, and heat up the collagen underneath the skin.
Take pain medications only if needed as prescribed. Certain pain medications can cause nausea or intolerance. Please discontinue if that occurs, and call office to inform us and we will change it.
Keep surgical site elevated as much as possible.
In most instances, fingers are free. So may use them to write, type, feed, and dress yourself.
Restrict lifting to 5 lbs or less.Expectations with carpal tunnel surgery
Night time pain should go away immediately. Numbness and tingling of the fingers can persist for up to three months, but should show improvement.
FAQHow Do I know that I have carpal tunnel syndrome?
Carpal tunnel syndrome is a diagnosis made by the patient’s history, the physical examination, and additional tests. Since it is a “Syndrome” and not a “Disease” an experienced physician will make the diagnosis putting these three components together. There is not one criteria, or test that is 100% accurate, and since other problems can mimic carpal tunnel syndrome, a thorough history and physical examination is important. Regarding tests, the EMG/NCV (electromyelogram and nerve conduction velocity) is usually the best test, although ultrasound, MRI, and diagnostic steroid injections have also been used to help make the diagnosis.Is Minimally Invasive Endoscopic No Stitch Carpal Tunnel Release effective?
Endoscopic No Stitch Carpal Tunnel release when performed by an experienced surgeon is effective. 98% of patients with a diagnosis of carpal tunnel syndrome that have had an endoscopic no stitch carpal tunnel release have had improvement or complete resolution of symptoms. The advantage is a smaller scar and sometimes you do not even need stitches – they heal on their own! Not all hand surgeons can successfully perform an endoscopic no stitch carpal tunnel release. It is important to find out how many your surgeon has performed.Will the nighttime pain go away after Surgery?
The best part of an Endoscopic No Stitch Carpal Tunnel Release is that nighttime pain usually resolves immediately after surgery. Numbness and tingling can and will persist after surgery but should eventually subside. It could take up to three to four months for numbness and tingling to improve or resolve.What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is simply pressure on a nerve in your hand called the median nerve, at a specific location of your wrist – the carpal tunnel. For more information on carpal tunnel syndrome visit our dedicated carpal tunnel syndrome page and our no-stitch endoscopic carpal tunnel release site.