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Provider holding male patient's wrist brace

At the Penn Integrated Hand Program, we create individualized treatment plans designed to treat the whole person, not just the condition. Our team of orthopaedic surgeons, plastic surgeons, hand therapists and other experts is highly experienced in treating carpal tunnel syndrome.

This condition can be very debilitating, and our goal is to reduce or eliminate pain and get you back to normal activities. In some cases, we may simply immobilize your wrist in a splint to minimize or stop pressure on the nerve that is being constricted.

In other cases, when non-surgical treatments do not provide relief, your surgeon may recommend a surgical approach.

Non-Surgical Treatment for Carpal Tunnel

If you are diagnosed with carpal tunnel syndrome, your doctor may start you on non-surgical treatments. Non-surgical treatment options include:

  • Hand and wrist brace - The first line of treatment is usually to wear a brace that puts the compressed nerve in a position where it's no longer being constricted.
  • Anti-inflammatory medication - Nerves in the hand are surrounded by tendons that may become inflamed from overuse. Anti-inflammatory medication reduces swelling and inflammation, which can help relieve symptoms.
  • Injections - If you have mild symptoms and bracing and anti-inflammatories do not provide relief, the next option is a steroid injection into the carpal tunnel. The goal of the injection is to reduce swelling in the connective tissue and relieve pressure on the median nerve.

Carpal Tunnel Release Surgery

The most common surgical procedure for carpal tunnel is called a carpal tunnel release. This type of surgery can be performed through an open incision in your palm or through a smaller incision using a minimally-invasive technique with an endoscope. Our surgeons are highly skilled at performing both open incision and endoscopic techniques.

  • Open Carpal Tunnel Release - Orthopaedic surgeons perform carpal tunnel release through an incision in the palm of your hand, usually under local anesthesia. The incision is about two inches long. Once the incision is made, your surgeon will cut the carpal ligament that is pressing on the nerve and then seal the incision with a few stitches.
  • Endoscopic Carpal Tunnel Release - Carpal tunnel release surgery can also be performed with an endoscope, a thin, flexible tube with a tiny camera used to view the surgery site. Your surgeon will make one or two small incisions and then slide the camera under the ligament to perform the surgery. Endoscopy is often preferred because it may allow you to return to your normal activities sooner.

Minimally invasive surgery means easier recovery

Whenever possible, our surgeons perform surgery using only local anesthesia while the patient is wide awake. This minimally invasive technique is known as wide-awake local anesthesia, no tourniquet (WALANT).

With no need for general anesthesia or sedation, patients experience quicker recovery times, have a lower risk of side effects and complications and do not require an IV.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition that causes pain, numbness and tingling in the hand and arm. It occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.

When the median nerve doesn't have enough space, or is not able to get enough blood flow and oxygen, the nerve will send messages to the brain indicating there is a problem in the hand. The brain then produces feelings of pain, numbness and tingling in the hand and wrist.

Sometimes you’ll find that only certain fingers go numb with carpal tunnel syndrome because of nerve compressions of the upper extremity. Carpal tunnel syndrome can also feel like a burning sensation. You may lose dexterity in the hand and be unable to create a fine pinch.

If left untreated, carpal tunnel can cause your muscles to waste or shrink. Because of this, it's important to see a hand specialist if you feel any pain or numbness. Our surgeons successfully evaluate and treat many individuals with carpal tunnel.

What causes carpal tunnel syndrome?

Carpal tunnel syndrome is associated with certain types of diseases such as:

  • Alcohol use disorder
  • Diabetes
  • Inflammatory arthritis such as rheumatoid arthritis
  • Low thyroid function
  • Other metabolic disorders
  • Post traumatic injury such as a previous wrist fracture

If you work in the construction or manufacturing industries, you may experience symptoms of carpal tunnel.

Diagnosing Carpal Tunnel Syndrome

A precise and accurate diagnosis translates to the best possible treatment and patient outcomes. Our orthopaedic specialists have the expertise, knowledge and experience to accurately diagnose carpal tunnel syndrome using the latest diagnostic approaches.

One of the most accurate ways to diagnose carpal tunnel is through nerve conduction testing. Nerve conduction testing are electrodiagnostic tests that measure the electrical activity of muscles and nerves. Once your nerve study is complete, our surgeons will determine if you are a candidate for hand and wrist surgery and will discuss next steps.

Carpal Tunnel in the Neck

Carpal tunnel syndrome can sometimes begin in the neck. The median nerve runs all the way down from the neck to your fingers. If you have a history of neck problems, you may be at an increased risk of carpal tunnel syndrome.

Our surgeons will determine if your carpal tunnel is due to a problem in your neck and will provide the appropriate treatment.

Carpal Tunnel Syndrome in Pregnancy

Carpal tunnel can sometimes occur during pregnancy. It usually happens during the last trimester due to fluid accumulation in the body. If fluid builds up in the carpal tunnel, it compresses the median nerve and causes tingling and numbness in the hands and fingers.

When women have carpal tunnel during pregnancy, our orthopaedic specialists work with Penn obstetricians to ensure seamless care and a safe pregnancy. In most cases, we recommend wearing a splint at night to prevent bending the palm down toward the wrist, which causes restricted blood flow to the nerve. In severe cases, we may choose to give you a corticosteroid injection to provide relief.

Usually carpal tunnel in pregnant women will clear up after birth. If pain persists, you should make an appointment with one of our orthopaedic specialists. To contact us, please call 800-789-7366 or fill out our contact form.

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