by Brandon Devers, MD
Hand and Upper Extremity Surgeon
Lexington Clinic Orthopedics - Sports Medicine Center
Carpal tunnel syndrome refers to compression of the median nerve at the level of the palm. It is caused by increased pressure within the carpal tunnel, which results in symptoms related to nerve compression. These symptoms primarily include numbness and tingling in the hand, specifically the thumb, index finger, middle finger and occasionally the ring finger. Symptoms are not typically present within the small finger. Symptoms tend to be worse at night due to our sleeping posture and may frequently wake you up from sleep. This is why treatment early on with a wrist splint may result in improved symptoms as the splint keeps the wrist from bending while we sleep at night. You may also notice symptoms during the day with certain activities such as working, typing, or driving and may notice that you will frequently shake out or adjust the position of your hand or wrist to obtain temporary symptom relief.

Typically the cause of carpal tunnel syndrome is multifactorial and can be related to medical conditions such as diabetes, thyroid disease, or rheumatoid arthritis as well as activities involving repetitive use of the hand, repeated impact across the palm, or use of vibratory tools. Carpal tunnel syndrome is typically diagnosed by routine clinical exam findings as well as a nerve conduction study to help verify the presence of carpal tunnel syndrome and to assess the underlying severity. When conservative treatment measures such as splinting, activity modification, and occasionally steroid injections fail to provide symptom relief or when the nerve conduction study reveals severe compression of the carpal tunnel, then surgery is recommended.

Surgical treatment options include standard open carpal tunnel release, limited or mini open carpal tunnel release, and endoscopic carpal tunnel release all with the goal of releasing the overlying ligament or roof of the tunnel to decrease pressure on the underlying nerve. My surgical preference is for endoscopic carpal tunnel release as this minimally invasive procedure results in the same clinical improvements as the standard open release, but with quicker functional recovery, less scar tenderness, and faster return to work compared to the traditional open procedure.

The endoscopic carpal tunnel procedure involves making a small incision within the wrist crease, which avoids placing the incision and subsequent scar tissue through the thicker skin of the palm. This is followed by insertion of a camera with a small blade, which allows for release of the carpal tunnel ligament directly from with inside the tunnel itself. The wound is closed with small buried sutures.  

I allow immediate use of the hand and fingers for light activities such as eating, drinking, typing, and writing but instruct my patients to avoid gripping, pushing, or pulling anything more than 5 pounds for the first 2 weeks. Patients do not typically require any splinting or therapy following surgery. At the 2 week follow-up appointment, if the wound has successfully healed, I will then allow patients to gradually return to activity with the hand as tolerated, keeping in mind that the palm may be sore to some degree with heavy gripping or lifting for 2-3 months. Endoscopic carpal tunnel surgery is just one of the many minimally invasive procedures we provide here at the Lexington Clinic Orthopedic and Sports Medicine Center.

Brandon Devers, MD, Lexington Clinic Hand Surgery
Dr. Brandon Devers is board-certified in orthopedic surgery. He specializes in orthopedic hand and upper extremity surgery and provides services in general orthopedics, traumatic injuries and workers’ compensation. His professional interests involve hand and upper extremity surgery, hand, wrist and elbow fractures, tendon and ligament injuries, nerve compression and injuries, endoscopic carpal tunnel release, wrist arthroscopy, athletic injuries, arthritis in the upper extremity and work-related injuries.