Carpal Tunnel

Dr. Steven Rueda is one of the most sought after surgeons for carpal tunnel syndrome in Palm Beach. Carpal Tunnel Syndrome is a condition that affects a nerve in the wrist. This nerve is called the “median nerve”, and is responsible for providing sensation to the thumb, index, middle, and half of the ring finger in the palm of the hand. It also provides nerves to the muscles in the hand that help bring the thumb to the pinky, and other muscles that assist in finger motion.

Carpal Tunnel Symptoms and Diagnosis

The symptoms arising from carpal tunnel syndrome reflect the function of the pinched nerve at the wrist explained in the prior section. Some of the most common symptoms include:

 

  • Numbness of the hands (specially thumb, index, and middle finger)
  • Tingling of the hands
  • Weakness of the hands
  • Pain in the hands
  • Night time awakening from symptoms

In some cases patients present with all of the symptoms, and in some cases only with some of them. In rare occasions, some patient’s may present with carpal tunnel causing numbness of all the fingers in the hand.

The diagnosis of carpal tunnel syndrome is given using a combination of history, clinical examination, and nerve studies. A typical history and examination performed by a hand surgeon are usually enough to diagnose the condition. Nerves studies, also known as nerve conduction studies and electromyography (NCS and EMG), may be ordered to confirm the diagnosis or grade de severity.

WHAT CAUSES Carpal Tunnel?

It is called “carpal tunnel syndrome”, because of the location where the nerve is pinched in the wrist. The carpal tunnel consist of a floor, walls, and a roof. The floor and walls are made by the hard bones of the wrist. It’s roof is a ligament called the “transverse carpal ligament”. Inside the space bound by the bones and the ligament are tendons and the median nerve. In people affected by carpal tunnel syndrome, there is swelling inside the carpal tunnel. Given that the walls, floor, and roof are hard structures without room to expand, this swelling leads to compression and pinching of the median nerve. Ultimately symptoms of numbness, tingling, weakness and pain ensue.

Carpal Tunnel Treatment Options

There are three main ways to treat carpal tunnel: activity modification and splints, steroid injections, and surgery. Most patient’s with recent onset mild or moderate carpal tunnel syndrome are good candidates for splints and activity modification. Steroid injections are indicated in very select situations, and should not be used in patients where nerve damage is evident. Surgery is indicated for patients with moderate or severe carpal tunnel that has failed conservative treatment. Not having surgery when its needed may lead to permanent hand numbness and weakness, often causing severe hand dysfunction.

Carpal Tunnel Procedure

Dr. Rueda performs three types of carpal tunnel surgery: endoscopic, mini-open, and traditional open. The three procedures release the ligament at the roof of the carpal tunnel (transverse carpal ligament). This release generates more space in the tunnel and allows the nerve pressure to be reduced, therefore relieving symptoms.

Incisions

Made and hidden along a horizontal wrist crease

Incisions

Made and hidden along a vertical crease in the base of the palm of 1.5cm.

Incisions

Made along a vertical crease in the base of the palm of 3-4cms.

RECOVERY AND DOWNTIME

Outpatient procedure. Most patients are actually surprised at having less pain that they expected. There is tightness, swelling and bruising for first few days after surgery. An elastic bandage is applied and removed in a day or two and patients are free to wash their hands. Some medical studies suggest the endoscopic and mini open procedures lead to less postoperative pain and earlier return to work. Numbness, tingling, and pain gets better rapidly after the surgery for those with mild to moderate carpal tunnel. Those with severe carpal tunnel usually improve but may have residual symptoms.

Most patients generally return to work in 1 week. Exercise is not allowed until 3 weeks after the surgery.

Why Choose Precision Hand Center for your Carpal Tunnel Procedure?

Dr. Rueda, a Hand Fellowship trained surgeon who has 7 years and 2,000 procedures of experience will be your safe and best choice for carpal tunnel. Successful results in this procedure requires a surgeon that is experienced and knowledgeable in hand surgery and hand anatomy. Dr. Rueda has published articles in expert peer reviewed journals and his work has been presented in several national conferences. Dr. Rueda’s passion for patient education and custom centered approach will guarantee you feel comfortable every step of the way. Dr. Rueda also believes in treating his patients as if he was treating his own family; you can trust you will enter a trusting and long-term relationship and have some of the best carpal tunnel syndrome treatment Palm Beach can offer.

FREQUENTLY ASKED QUESTIONS (FAQ)

Patients with classic history, symptoms, and exam who have failed conservative treatment or those who have severe carpal tunnel are good candidates for the procedure.

It is uncommon but its possible. This is known as recurrent carpal tunnel syndrome. These patients typically have improvement after the initial surgery, but symptoms returned months to years afterwards. It is thought to occur from pinching of the nerve at the carpal tunnel from scar tissue. Treatment is focused on releasing the nerve from scar and using tissue around it to protect it from scarring in the future

Complications are very rare in carpal tunnel surgery; it is a very safe procedure. Some of the uncommon risks include infection and bleeding of the surgical site after infection. There are also other major complications that are very unlikely including persistent pain and nerve injury.