In the wrist, the median nerve (the major "communication line" between the brain and the hand) is routed through a small passage bounded by the wrist bones (the carpals) and the tough ligament tissue connecting them (see diagram). Nine hard tendons also pass through this crowded "carpal tunnel". Because this structure is rigid, any influence that causes tissue swelling within the tunnel or reduces its size tends to compress and pinch the median nerve.
When symptoms of carpal tunnel syndrome are minor or occur only during sleep,
relatively simple measures to minimize swelling or otherwise limit median
nerve compression may provide effective relief. Such efforts might include:
In a large percentage of cases, one or more of these non-operative measures are effective in controlling the symptoms of carpal tunnel syndrome.
When these initial efforts fail to control symptoms, however, an operation called a carpal tunnel release is indicated. In this relatively simple outpatient procedure, the surgeon carefully cuts the wrist ligament, releasing the pressure inside the carpal tunnel, usually providing almost instantaneous relief from arm and hand pain and tingling.
As the wound heals, new tissue will bridge the severed ligament in about six weeks, making the ligament long enough to create additional space inside the tunnel and prevent recurrence of symptoms in most cases.
The hand surgeon is specifically trained and experienced in diagnosing, treating and, when possible, preventing disorders of the hand and upper extremity. A hand surgeon will generally have available all effective methods of carpal tunnel evaluation and treatment.
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