- Hand reconstructive procedure
- Medicare and health insurance rebates
- Day procedure only
Carpal tunnel syndrome is a painful disorder of the hands. Symptoms range from mild to severe and may include everything from simple numbness to pins and needles and debilitating pain, particularly at night. Carpal tunnel syndrome is the result of pressure on nerves that run through the wrist. In the last century, carpal tunnel syndrome was frequently a problem for people who used typewriters. It also troubled athletes such as tennis players who over-use their wrists. Today, carpal tunnel syndrome is associated with excessive computer keyboard use. However, anything that causes swelling inside the wrist can cause carpal tunnel syndrome, including repetitive hand movements, pregnancy and arthritis. There are no statistics for the number of CTS surgeries performed in Australia each year. In the U.S., however, the N.Y. Times reports that more than 500,000 people undergo surgeries for carpal tunnel syndrome in America, where surgery for CTS is among the most common hand surgery.
Treatment for Carpal Tunnel Syndrome
Carpal tunnel syndrome can be relieved and reversed by reducing the pressure on the median nerve in the wrist. This can be accomplished with a range of treatments including
- Rest for the affected hand.
- Wearing splints on the affected wrist and hand at night.
- Diuretic medications to reduce the body’s retention of fluid.
- Cortisone tablets.
- An injection of local anaesthetic and a corticosteroid medication into the affected area to reduce the swelling.
At present, there is no scientific evidence that general hand or wrist exercises relieve the symptoms of carpal tunnel syndrome. More research is needed to understand whether specialised hand exercises – called nerve tendon and gliding exercises – can help. For patients who need more relief than these options provide, hand surgery is suggested.
Dr Norris suggests that that to ensure a correct diagnosis has been made a positive nerve conduction study needs to be performed. Once these results are in then Dr Norris can discuss the surgical options to correct the problem.
Who Is a Good Candidate for Hand Surgery
Prior to scheduling hand surgery to relieve carpal tunnel syndrome, patients should explore non-surgical treatments for a minimum of 5-12 months, depending on the severity of the condition. In the event that nerve damage is present, particularly damage to the median nerve, scheduling surgery sooner rather than later may be beneficial.
Factors that can increase the chances for a good surgical outcome:
- General good health.
- A positive attitude and realistic expectations.
- Symptoms that are worse at night than during the day.
- Surgery performed within 3 years of being diagnosed with CTS.
Factors that can have a negative impact on the outcome of hand surgery include:
- Severe symptoms before surgery.
- Alcohol abuse
- Work requiring the use of vibrating tools. (Research has found that only slightly more than half the people who used vibrating hand-held tools were symptom-free 3 years after a CTS operation.)
- Very poor nerve conduction results before surgery.
Patients with diabetes and high blood pressure may be more likely to require a second operation. Patients who are on haemodialysis have good initial success, but the condition deteriorates in about half of them after about a year and a half.
What to Expect Before, During & After Hand Surgery
Our resident surgeon, Dr. Benjamin Norris will talk with you to determine which of three common hand surgeries will provide the best treatment for your carpal tunnel syndrome:
- Open Release Hand Surgery – In this surgery, the carpal ligament is cut free (released) from the median nerve, thereby relieving any pressure. The surgery is straightforward.
- Endoscopic Hand Surgery – This treatment for carpal tunnel syndrome is a less invasive procedure than standard open release. The surgeon inserts pencil-thin tubes (endoscopes) into one-centimetre-long incisions made in the wrist and palm. The surgeon then places a camera into the tubes, which allows him/her to see the underside of the carpal ligament on a screen. Using that view as a guide, the surgeon inserts a knife into another tube and cuts the ligament to free the compressed median nerve.
- Mini-Open Hand Surgery – A recent advancement in hand surgery, the mini-open procedure, is also known as a short incision procedure. For this surgery, the surgeon makes a one-centimetre incision that offers a direct view of the area. The short incision hand surgery may allow for quicker recovery while avoiding some of the complications of endoscopy (below). Because it is so new, however, few studies have investigated its benefits and risks.
For many patients, hand surgery can relieve carpal tunnel syndrome symptoms of numbness and tingling immediately. In various trials, 70-90% of patients who underwent hand surgery were free of night-time pain afterward. Recovery from carpal tunnel surgery is slow. Immediately after surgery patients usually experience a decline in grip strength and dexterity. People who have the procedure on both hands at the same time are completely incapacitated for about 2 weeks and will need someone to help them at home. Returning to strenuous work immediately after surgery can cause the symptoms to return. It is generally recommended, therefore, that patients take a month off work (or longer), depending upon the type of surgery and the severity of the condition. Peak improvement may not be achieved for as long as ten months, and the scar may remain tender for up to a year. Recovery time does appear to be faster with endoscopy than with open release, and patients who have open release surgery appear more likely to require repeat operations than those who have had endoscopic surgery.
Risks & Complications Associated with Correcting Carpal Tunnel Syndromes
Loss of some wrist strength is a complication that affects 10% to 30% of hand surgery patients. Other complications can include:
- Nerve damage with tingling and numbness (usually temporary)
Irreversible nerve injury with endoscopic carpal tunnel release (vs. open carpal tunnel release) is a concern because of reduced visibility. However, studies have shown an extremely low number of complications following the procedure, when performed by surgeons experienced in the technique. Pain and other symptoms may return due to incomplete release of the ligament, extensive scarring, or recurrence of the syndrome due to an underlying medical condition. Should that be the case, the release procedure may need to be repeated.
Cost of Hand Surgery
It is impossible to quote an average cost for hand surgery to relieve carpal tunnel syndrome because there are many variables involved. For example, a surgeon’s cost will be based on the exact procedure you need, his or her experience, geographic office location and other factors. Beyond the cost of the hand surgery itself, there might also be expenses for medication and post operative visits. If you have been suffering from wrist pain, schedule a consultation with us. Together we can discuss hand surgery and non-surgical treatments for carpal tunnel syndrome and devise a personalised treatment plan and price estimate for you.