Surgery for carpal tunnel syndrome
- Alice A Hunter, MD
Alice A Hunter, MD
- Staff Orthopedist
- Lahey Hospital and Medical Center
- Barry P Simmons, MD
Barry P Simmons, MD
- Associate Professor of Orthopaedic Surgery
- Harvard Medical School
- Section Editors
- Charles E Butler, MD, FACS
Charles E Butler, MD, FACS
- Section Editor — Plastic and Reconstructive Surgery
- The University of Texas, MD Anderson Cancer Center
- Jeremy M Shefner, MD, PhD
Jeremy M Shefner, MD, PhD
- Section Editor — Neuromuscular Disease
- Professor and Chair of Neurology, Barrow Neurological Institute
- Professor of Neurology, University of Arizona, Phoenix
- Clinical Professor of Neurology, Creighton University
Carpal tunnel syndrome (CTS) is a common nerve entrapment disorder manifested by pain, paresthesias, and ultimately muscle wasting of the hand. Appropriate treatment can interrupt the progression of this disorder and avoid the development of permanent disability. Conservative therapy may be sufficient, although many patients require surgery. Surgical treatment may involve open or endoscopic technique. The goal of either approach is to decrease pressure upon the median nerve at the wrist by dividing the transverse carpal ligament and antebrachial fascia.
This topic review will discuss the surgical treatment of CTS. The clinical manifestations, diagnosis, and conservative therapy of this disorder are reviewed elsewhere. (See "Carpal tunnel syndrome: Clinical manifestations and diagnosis" and "Carpal tunnel syndrome: Treatment and prognosis".)
Indications for surgery include persistent numbness and pain, motor dysfunction with diminished grip or pinch grasping, or thenar eminence flattening.
Prior to contemplating surgical carpal tunnel release, one must be sure of the correct diagnosis. Although median nerve entrapment at the wrist is the most common and most well-studied manifestation of CTS, it is often confused with other disorders, such as cervical radiculopathy, thoracic outlet syndrome and pronator syndrome.
The symptoms of carpal tunnel syndrome include numbness and tingling in the hand, especially if confined to the median nerve distribution. The symptoms are often worse at night but can also be present in the daytime in the worker with a provocative job. Symptoms are often worse with driving or holding a book, newspaper, or telephone .
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- ANATOMY OF THE CARPAL TUNNEL
- Median nerve
- SURGICAL TECHNIQUES
- Open technique
- - Standard incision
- - Small palmar incision
- Endoscopic technique
- - One-portal approach
- - Two-portal approach
- POSTOPERATIVE CARE
- Open versus endoscopic complications
- Open versus endoscopic techniques
- SUMMARY AND RECOMMENDATIONS