Carpal Tunnel

Carpal Tunnel Syndrome surgery in Montreal

Carpal tunnel syndrome causes pain in the wrist and hand that can impact your ability to function on a daily basis, and affect your overall quality of life.

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.

Carpal Tunnel Syndrome is not a single condition. Rather, it is a collection of symptoms commonly caused by other underlying conditions. In simple terms, swelling inside the narrow carpal tunnel in the wrist is the cause of the pain. A variety of conditions contribute to carpal tunnel syndrome so your doctor will usually look for underlying causes.

The Carpal Tunnel is a narrow passageway between the wrist and the hand. The wrist bones lie underneath it and the transverse carpal ligament sits over the top. Inside the carpal tunnel is the median nerve, which gives feeling to the thumb, index finger, third finger and half of the ring finger. Several tendons also pass through this narrow space. When swelling occurs, these tendons squash or constrict the large median nerve. Symptoms of numbness and pain and reduced function are the result.

    Carpal Tunnel Syndrome surgery in Montreal

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    Causes of Carpal Tunnel Syndrome

    While sometimes the cause of Carpal Tunnel Syndrome remains a mystery, the following conditions are common causes:

     

    • Pregnancy can cause fluid retention which leads to swelling.
    • Arthritis often causes swelling and inflammation.
    • Wrist fracture, when a fragment of bone irritates surrounding tissue.
    • Overuse of the hand or wrist, especially when using awkward or repetitive movements. Common examples of this include typing, smart phone use, gaming, e-sports, etc
    • Some people were born with a smaller carpal tunnel, making them more prone to problems.
    • Sprains.
    • Hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland.
    • Presence of a cyst or tumour in the canal.

    How is it diagnosed?

    Early diagnosis and treatment are important to avoid permanent damage to the median nerve. Fortunately, the diagnosis is usually straight forward and is made after finding a typical history and examination findings.
    The detailed history should include any other medical conditions, how the hands have been used, and whether there were any prior injuries or surgery.

    A physical examination of the hands, arms, shoulders, and neck can help determine if the patient’s complaints are related to daily activities or to an underlying disorder and can rule out other painful conditions that mimic CTS.

    Specific tests are also used to try to produce the symptoms of CTS. In the Tinel’s test, tapping or firmly pressing on the median nerve in the patient’s wrist is performed. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen’s test involves holding both upper limbs in a forward position and flexing the wrists by pressing the backs of the hands together. The presence of CTS is suggested if one or more symptoms, such as tingling or increasing numbness, are felt in the fingers within 1 minute. The earlier the onset of symptoms suggests a greater severity of CTS.

     

     

     

    Signs and Symptoms

    If you have any of the following symptoms of Carpal Tunnel Syndrome, it’s a good idea to make an appointment.  Early intervention often means treatment is more effective.

    • Weakness in your hand.
    • Diminished grip strength.
    • You have pain that radiates into your arm or shoulder.
    • You have stabbing pain in your wrist.
    • You experience numbness or pins and needles in your wrist or hand.
    • Tingling sensation in all the fingers except little finger.
    • Swollen feeling in the fingers.
    • Burning or tingling in the fingers, especially the thumb and the index and middle fingers.
    • Pain or numbness that is worse at night, interrupting sleep.

    As symptoms worsen, people develop symptoms during the day. This can progress to hand clumsiness and weakness, making it difficult to form a fist, grasp small objects or perform other manual tasks.

    Chronic and/or untreated cases will cause permanent nerve damage with resultant permanent weakness and numbness in the hand.

     

    Treatment

    Treatments for carpal tunnel syndrome should begin as early as possible.
    NON-SURGICAL – Symptoms may often be relieved without surgery.

    • Identify treatable causes for the condition – eg. underlying causes such as diabetes
    • Activity modification – avoiding activities that may worsen symptoms, and immobilising the wrist in a splint to avoid further damage from twisting or bending.
    • Night Splints (wrist brace holds wrist straight and opens up the tunnel)
    • Weight loss and fitness training
    • Anti-inflammatory drugs – may ease symptoms 
    • Cortisone injections into the carpal tunnel may help relieve the symptoms

    SURGICAL – Carpal tunnel release is one of the most common hand surgical procedures.

    Surgery is designed to make more room for the nerve. Pressure on the nerve is decreased by cutting the transverse carpal ligament that forms the roof of the tunnel. Incisions for this surgery may vary, but the goal is the same – to enlarge the tunnel and decrease pressure on the nerve. The procedure can be done under a general or local anaesthetic as a day only basis, unless there are unusual medical considerations.

     

     

    What To Expect After Carpal Tunnel Surgery

    Following your doctor’s orders is the best thing you can do to experience optimal recovery. Your doctor will likely have you elevate your wrist above your heart to keep the swelling down. Icing the surgical site, massaging the palm of your hand, taking your pain medication, and moving your fingers are all recommendations your doctor may make.

    Carpal tunnel surgery can take several months to a year for a full recovery. If you have open release surgery, your recovery time is generally longer as the procedure is slightly more invasive. However, you should have the full range of motion back after a month if you follow the physical therapist and doctor’s orders. You should also be able to return to work after six to eight weeks if the surgery was done on your dominant hand.

    • Around 1 week after surgery: Removal of bandages and stitches will take place. Physical therapy may be suggested to improve stiffness and restore range of motion.
    • Weeks 2 – 4: You may gradually resume activity in the affected hand. Pain and soreness in the palm are expected to slowly decrease.
    • 4 weeks: You will likely regain full mobility of the digits or will be working with a therapist to regain mobility.
    • 6 – 8 weeks: You may still experience soreness in your palm and sensitivity to deep pressure or touch, but you should be able to participate fully in daily life and sporting activities.

    Proper follow-up care is key for a successful recovery. Be sure to go to all your follow-up appointments as directed and call the office if you have any issues or questions.

    Our office is always available for questions via email or text message should more questions arise.

     

    How to Take Care of Your Hand After Carpal Tunnel Surgery

    Most patients wear a splint or heavy bandage for up to two weeks after surgery. You may need to have a follow-up appointment to remove the dressing.

    If your hand is in a splint following the surgery, you should be sure to move your fingers periodically to combat stiffness. To reduce the swelling in your hand after surgery, you may have to keep your hand elevated while you sleep.

    Following the removal of the splint, it’s time to begin physical therapy. You’ll engage in motion exercises to strengthen your wrist and hand, though you may still have to occasionally use the splint when your hand hurts.

    Your surgeon may restrict your activities for some time after the surgery. For instance, if your work involves typing, you may have to stay home for a while or modify your work. How you progress after surgery depends on a number of factors, including:

    • Age.
    • Health and the presence of preexisting conditions, such as arthritis.
    • How well you listen to the surgeon’s instructions.

    You will see immediate progress soon after the surgery, but it could be three months to a year before you realize all the benefits of the procedure. Grip strength returns about three months afterward, and you can begin participating in sports about two months later as long as you don’t experience a lot of pain.

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