Carpal tunnel surgery


Carpal tunnel surgery which is also known as a carpal tunnel release (CTR) is a common orthopedic procedure, with over 200,000 performed each year!

MOST hand surgeons and/or orthopedists will typically wait anywhere from 3 to 6 months, if not longer before recommending surgery.
However, it all depends on the SEVERITY of your carpal tunnel syndrome (CTS), your symptoms and any particular risk factors you might have and how you are responding to conservative or Nonsurgical treatment. It can also depend on what is the cause of your carpal tunnel syndrome.

....So, having said all that, this article will focus on the



TWO MAIN TYPES OF CARPAL TUNNEL SURGERY

But first, lets assume you have been worked-up for other causes and diagnoses and your doctor is aware of the other conditions that can mimic Carpal tunnel syndrome, and that you have been correctly diagnosed with CTS and you have failed conservative treatment. (meaning you have gotten little or no relief of your carpal tunnel symptoms)....AND it has been at least 3 to 6 months.



If you have other questions about whether you should have a carpal tunnel release, See these articles on
Deciding about carpal tunnel surgery.

"Should I have carpal tunnel surgery?"
Reasons NOT to have carpal tunnel surgery
Don't Rush into carpal tunnel release surgery

The Goal of the Surgery is to reduce the pressure on the median nerve by surgically cutting or "releasing" the TRANSVERSE LIGAMENT. This allows the tunnel or the canal to be opened up more so the median nerve and tendons are no longer being squeezed or tightened.

For more information See ANATOMY OF THE CARPAL TUNNEL
ALTHOUGH there are several different variations of a carpal tunnel procedure, as mentioned earlier, they can be divided into

TWO MAIN TYPES:

ENDOSCOPIC CARPAL TUNNEL SURGERY

OPEN CARPAL TUNNEL RELEASE (SURGERY)

The one that your hand surgeon uses, really depends on his/her preference, experience and skill level.
It's been my experience in general, that most of the "younger" orthopedists and hand surgeons practicing today favor some form of the endoscopic carpal tunnel release surgery (ECTR). Due to the growing popularity of ECTR they probably have learned and trained how to do this procedure during their residency more so than the open release procedure.

Many of the "older" orthopedic surgeons...say 50-60 years and older, probably feel more comfortable doing the more traditional open release procedure, because that's what was taught when they were doing their residency. However, many older surgeons, not to be left out, have gone back and have taken courses etc...on how to do the endoscopic procedures as well. So many of them feel quite comfortable doing either procedure.

Sometimes the surgery starts out as an endoscopic procedure, but then turns into an open procedure. This usually occurs if the surgeon can't get a clear view of the median nerve or transverse ligament or if the patient has some sort of abnormal wrist anatomy. It's not common but I have seen it happen a few times.
See other carpal tunnel surgery complications

So, how do you know which one to go with?...I tell my patients they need to go with whichever doctor they feel most comfortable with....that may sound silly, but what is even more sillier to me, is sometimes people will pick a doctor because he or she went to this school or that school or because they are from a certain state etc...instead of going with who you connected better to, or going with your gut instinct. Of course you should check him out and I have given you some tips on how to go about that. You should discuss your case with the surgeon and ask him why does he want to use that procedure over the other procedure etc..If his explanation sounds good to you, and you feel he listens to your concerns, and checks out in other areas then I would go with him or her...See these excellent tips on

How to choose the Best Carpal tunnel surgeon Also note, that some plastic surgeons and neurosurgeons perform carpal tunnel surgery as well..but I think about 90% are done by orthopedist surgeons.



Carpal tunnel release surgery should really be reserved for the more Severe or chronic cases of CTS and most studies show that moderate to severe cases of carpal tunnel syndrome, Do fair better with a carpal tunnel release, rather than with conservative or non-surgical treatments.

I also remind my patients that surgery of the carpal tunnel is NOT an EMERGENCY PROCEDURE! It's not like your are having a heart attack and you need to have by-pass surgery right away! You have time to look at all your options...and consider all the factors and information so you can make a good decision, along with your surgeon, as to whether you need the surgery or not.



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