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Carpal Tunnel Syndrome

What is the carpal tunnel?

The carpal tunnel is a tunnel within your wrist created by your wrist bones which make up the floor and walls of the tunnel and a ligament (transverse carpal ligament) which makes up the roof. The box created by the bones and the ligament contains 9 tendons and 1 very important nerve called the median nerve. As we age the ligament can become thicker over time and cause compression of the nerve causing progressive symptoms.

What are the symptoms of carpal tunnel syndrome?

The key symptoms of classic carpal tunnel syndrome are numbness and tingling in thumb, index and long fingers. This numbness is often worse at night and can even wake patients from their sleep. Typically there is improvement with shaking the hands or repositioning them by hanging the hand down at your side. Symptoms may affect one or both hands.

In mild to moderate disease patients may notice a loss of sensation. Some patients may have difficulty with fine motor activities or even drop objects. In severe disease some patients will start to notice a flattening of the hand musculature which implies muscle loss and in some cases can be permanent.

How is carpal tunnel syndrome diagnosed?

Carpal tunnel syndrome can be diagnosed by obtaining a detailed history and an examination alone. At your visit, Dr. Julka performs a complete nerve examination including an evaluation for nerve function, nerve irritability and any effect nerve compression is having on your hand muscles. In some cases where the diagnosis is uncertain a nerve conduction study and EMG is obtained.

What does a nerve conduction study and EMG entail?

A nerve conduction study and an EMG for carpal tunnel are tests of nerve function performed by a neurologist or rehab physician. These two tests are performed to determine the electrical conduction ability of your nerve as well as any effects your disease may have had on your muscles. This can help us diagnose your nerve issue as well as determine the severity.

How is carpal tunnel syndrome treated?

Carpal tunnel syndrome can be treated with non operative measures as well as surgical treatment. Mild disease is often treated with braces and/or a cortisone injection which is performed at the time of your visit. More severe disease or symptoms that fail to respond to non operative measures is treated with surgery.

Will my surgery be minimally invasive?

Dr. Julka has been a sought out leader in minimally invasive approach to carpal tunnel surgery. His technique has been published in peer reviewed journals and viewed internationally. Dr. Julka performs the majority of his carpal tunnel release surgeries endoscopically. This technique uses a small (1cm) incision in the wrist to access the carpal tunnel and perform the release with the use of a special camera. In a small number of patients that are not good candidates for endoscopic carpal tunnel release we use a second method of minimally invasive carpal tunnel release. We invite you to view Dr. Julka performing both surgeries in the videos below.

Endoscopic Carpal Tunnel

Mini Open Carpal Tunnel

Do I need general anesthesia for a carpal tunnel release?

The vast majority of our carpal tunnel release surgeries are performed with numbing of the hand with a local anesthetic as well as some mild sedation as you might receive during a colonoscopy. General anesthesia is almost never required.

Do I have to stay overnight in the hospital?

All of our carpal tunnel release surgeries are performed in a surgery center on an outpatient basis.

What can I do after my surgery?

You will be placed in a small soft bandage after your surgery. Unless instructed otherwise you will be allowed to remove your bandage in 48 hours and place a band aid over the incision. At this time you may use the hand for light activities, shower, and perform exercises gently on your own at home.

When can I get back to my normal activities?

After carpal tunnel release surgery we will release you back to your regular activities at 4-6 weeks. Patients who perform activities such as yoga, pushups or other activities that result on significant weight bearing through the palm may have to alter their activities till 8 weeks or more.

How do I know if I need to seek treatment?

There are cases of carpal tunnel disease that are largely asymptomic until the very late stages where muscle damage has occurred. For that reason I recommend evaluation sooner rather than later for most patients. If you are having progressive signs and symptoms of carpal tunnel, issues with dexterity, issues with hand strength which does not resolve quickly you may benefit from an evaluation.