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December 30, 2002
Many people associate carpal tunnel syndrome with cumbersome, restrictive wrist braces and debilitating pain. But, a simple 10-minute out-patient surgical procedure can bring relief for people with advanced carpal tunnel syndrome when conservative treatment fails.
The carpal tunnel is an opening or passageway in the wrist, between the forearm and the hand. The sides and bottom of the tunnel are made up of small wrist bones and the roof consists of a sturdy ligament, according to Dr. Mark Cohen, associate professor and director of the Hand and Elbow Section in Orthopedic Surgery at Rush-Presbyterian-St. Luke's Medical Center.
Cohen and his colleague, Dr. John J. Fernandez, assistant professor of Orthopedic Surgery, specialize in treating disorders of the hand and wrist. Carpal tunnel syndrome occurs when the nerve that travels through this tunnel gets compressed, causing numbness, tingling and occasionally pain in the fingers, Cohen said. Patients may also experience a sensation of weakness in the hand, clumsiness, and a tendency to drop objects.
Initial treatment involves an anti-inflammatory medication and sometimes modification of activity that may aggravate the patient's symptoms. A cortisone injection combined with a nighttime splint often helps many patients. For those patients who don’t respond to these conservative treatments, surgery may be needed. Surgery cures the condition by releasing pressure of the nerve as a result of releasing the ligament at the roof of the tunnel.
"Although a more complex, longer operation was used in the past, we now perform a procedure called a 'mini-open' technique through a half-inch incision in the palm of the hand," Fernandez said. He and Cohen use specially designed surgical instruments to open the ligament, making it 15 to 20 percent longer. Dr. James W. Strickland developed the instrumentation at the Indiana Hand Center in Indianapolis, where both Cohen and Fernandez were trained.
After the procedure, which typically takes between five and 10 minutes, a small bandage is put on the palm and wrist for five to seven days. Cohen said most patients can use their hand that night for normal activities such as eating and brushing their teeth. Formal physical therapy is rarely needed.
"We do between five and 10 of these procedures a week and it is one of the most straightforward surgical procedures with the most reliable outcome," Fernandez said. He added that in most cases, the surgery addresses the problem permanently so the patient has no recurrence.
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