Carpal tunnel syndrome is a specific group of symptoms that can include tingling, numbness, weakness, or pain in the fingers, thumb, hand, and occasionally in the forearm. These symptoms occur when there is pressure on the median nerve within the wrist. The carpal tunnel is a small space or “tunnel” in the wrist formed by the wrist bones (carpal bones) and a ligament (transverse carpal ligament). The median nerve and several tendons pass through the carpal tunnel from the forearm to the hand. The tendons are surrounded by tubes of tissue.
It is the most common nerve entrapment syndrome, characterized by paresthesias, typically nocturnal, and sometimes sensory loss and wasting in the median nerve distribution in the hand; often bilateral and affects women more than men; due to chronic entrapment of the median nerve at the wrist within the carpal tunnel.
Carpal tunnel syndrome occurs when the tissues surrounding the flexor tendons in the wrist swell and put pressure on the median nerve. These tissues are called the synovium. The synovium lubricates the tendons and makes it easier to move the fingers.This swelling of the synovium narrows the confined space of the carpal tunnel, and over time, crowds the nerve.
Many things contribute to the development of carpal tunnel syndrome:
The most common surgery for relieving carpal tunnel symptoms involves cutting the transverse carpal ligament to relieve pressure on the median nerve in the wrist. Two approaches for this surgery are:
• Open Sarpal Tunnel Release Surgery, which allows the doctor to see more of the inner tissues, including the full width of the transverse carpal ligament where it is to be cut. Open surgery requires an incision in the palm and wrist, which disturbs more of the tissues in the hand, and requires a longer recovery period. It leaves a larger scar than does endoscopic surgery. But there may be less chance of other complications. See a picture of open carpal tunnel surgery.
• Endoscopic Carpal Tunnel Release Surgery, which requires only a small incision at the wrist (single-portal technique) or at the wrist and palm (two-portal technique), and which disturbs less tissue in the hand. Recovery is quicker than with open surgery. And the scars heal more quickly, are smaller, and tend to be less painful at 3 months after surgery. There may be a slightly higher rate of reoperation after endoscopic carpal tunnel surgery. See a picture of endoscopic carpal tunnel surgery.
The chance of obtaining a significant benefit from surgery depends upon a wide variety of factors. Your neurosurgeon will give you an indication of the likelihood of success in your specific case.
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