Carpal Tunnel Syndrome

The gold standard for definitive treatment of this debilitating condition is surgical. Ultimately, there are two surgical options to treat Carpel tunnel syndrome: the open technique and the endoscopic technique. The endoscopic technique consistently allows less pain and quicker recovery than the open technique. One of a limited number of physicians in Connecticut specializing in hand surgery Doctor Jeffrey Arons is the surgeon with the most experience in the New Haven area with the use of the endoscopic technique, and has probably performed more endoscopic carpal tunnel releases than any other local surgeon.

Carpal Tunnel Syndrome often results in numbness and tingling that can make even simple tasks hard to accomplish. Many patients describe a feeling of coldness and even of pain that may radiate up the arm, even to the shoulder or neck. Classically, symptoms are worse at night and awaken patients from a sound sleep. Patients may have a weakened grip, worsening penmanship, and loss of dexterity. Patients may notice numbness and tingling while driving, holding a phone, book, newspaper, or a hairbrush. Symptoms tend to become more severe over time.

Classically, it is the thumb, pointer finger, and long finger that are involved, although part of the ring finger may be involved as well, and some patients also complain of the small finger being involved, but this may actually be a sign of another nerve (the ulnar nerve) involvement. The exact cause of carpal tunnel syndrome is unknown. It may have to do with the size of your wrist. Previous injury, obesity, rheumatoid arthritis, and diabetes may be related. Your particular type of employment or other extracurricular activities may also be substantial contributing factors.

The diagnosis of carpal tunnel syndrome is made by history and physical examination. An electrodiagnostic test/nerve conduction study also aids in the diagnosis and may help rule out other nerve problems. At the time of your initial consultation, an x-ray of the wrist is usually taken to exam the bones. Sometimes, blood work is necessary. Treatment involves altering or even discontinuing certain types of activities you may be performing with your hands, rest, splinting, occupational therapy, anti-inflammatory medications, and sometimes a cortisone injection. Our office offers the availability of a certified hand therapist on site.

There are two surgical techniques employed to treat CTS, the open technique and the endoscopic technique. While both are effective, the less invasive endoscopic technique typically leads to a shorter, less painful recovery. Risks of both the open and endoscopic technique involve anesthetic complications, scarring, infection, stiffness, incomplete relief of symptoms, pain syndromes, injury to adjacent structures, and in rare cases, actual worsening of symptoms. Patients over 65 or 70, tend to have persistent numbness and tingling, although it is almost always improved. Even elderly patients, in their 80s and 90s, can experience significant relief, if nothing more than that they can sleep better through the night. Return to work is rapid after using the endoscopic technique, with some patients returning to desk jobs within a day or two. More commonly, however, most patients can return to their full daily activities by approximately two weeks, although patients who perform more strenuous work with their hands may require six weeks or more. The surgery is performed under local anesthesia with intravenous sedation as an outpatient.