Carpal Tunnel

About

As a hand surgery specialists in northern NJ, Dr. Janet Yueh at Cohen/Winters Plastic Surgery sees patients of all ages plagued by carpal tunnel syndrome in our Bergen County office.

The need for carpal tunnel surgery is expanding due to repetitive stress damage that can often occur from demanding workplaces, sports activities and using the keyboard on portable computers, pads laptops and mobile phones.

Unfortunately, not all work or leisure activities can be automated or done by voice command, nor would we want them to be, so carpal tunnel syndrome continues to be a major clinical problem.

The most prevalent complaint amongst carpal tunnel syndrome patients is “paroxysmal nocturnal paresthesias.” This is numbness and tingling that consistently awakens people from sleep at night.

Discomfort from carpal tunnel can become severe and disabling in the hand, wrist and forearm and usually presents as “pins and needles” and/or numbness. Many people think that carpal tunnel is a minor issue causing a slightly sore wrist, but those who suffer from it everyday long for permanent relief.

In advanced stages, the problem may lead to muscle wasting, clumsiness and intractable numbness. That’s what led Dr. Janet Yueh of Cohen/Winters northern NJ plastic surgery practice to become interested in helping this large group of patients. Dr. Yueh offers patients the advantage of years of training in hand/microsurgery including carpal tunnel, hand reconstruction and treatment of hand deformities in children and adults.

What Is the Carpal Tunnel?

The carpal tunnel is aptly named–it resembles a narrow tunnel. The wrist (carpal) bones make up the tunnel’s sides and floor. Across the top runs the transverse carpal ligament, a type of connective tissue.

Running through the tunnel from forearm to hand are flexor tendons (used to bend fingers and thumb) and the median nerve (providing sensation to portions of the thumb, fingers and palm as well as select movements of the thumb).

What Causes Carpal Tunnel Syndrome?

When synovial tissues, which produce fluid to moisturize the tendons and enable finger movement, become inflamed, they crowd the wrist’s flexor tendons. This creates pressure on the median nerve.

Causes of carpal tunnel typically include more than one of the following:

• Hand usage and repetitive wrist motions over time.
• Aging.
• Genetics dictate that the wrist’s carpal tunnels are smaller in some people. The trait runs in both men and women in certain families, but the problem is more frequent in women.
• Hormonal and fluid changes during pregnancy and various disease states can contribute to the problem.
• Diseases like rheumatoid arthritis (RA), diabetes and thyroid imbalances can also factor in.

Conservative treatment in the form of splinting, anti inflammatory medications and occasionally a cortisone injection is preferred but doesn’t always produce the necessary results for patients.

This should lead men and women with stubborn carpal tunnel problems to look for solutions in a New Jersey plastic surgeon’s office for specialized hand/wrist surgery.

Seeking Carpal Tunnel Treatment

Corrective carpal tunnel hand surgery can restore an individual’s ability to move freely and handle both work and living requirements to restore normal quality of life. Sleeping through the night without awakening with numbness and tingling is perhaps the most under appreciated benefit.

Besides relief from pain and numbness, carpal tunnel sufferers can regain independence and enjoy their favorite leisure activities once again.

Factors that lead patients to seek treatment include:

• Progressively limited hand function due to numbness and/or weakness (often more severe in the thumb, index and long fingers).
• Numbness and/or weakness that worsens when holding something in the hand, like a book or steering wheel.
• Electric shock sensations in the fingers and thumb.
• Symptoms gradually worsen and may interrupt from sleep.
• Moving or shaking of the hands/wrists that may decrease the pain and numbness.
• Persistent numbness or visible wasting of muscles at the base of the thumb in advanced/longstanding cases.

What Happens In Carpal Tunnel Hand Surgery?

Carpal tunnel surgery is tailored to each patient’s needs and is generally an outpatient procedure performed under local, regional or light sedative anesthesia.

During the surgery, a cut is made in the palm or may be done endoscopically, with a tiny camera through a minimal incision, if appropriate. The transverse ligament is divided to ease pressure on the nerve. The ligament generally doesn’t regrow across the divide, leaving more room for the flexor tendons and nerve and preventing recurrence.

Who Is a Good Candidate for Surgery?

The best candidate for carpal tunnel surgical treatment is a Northern NJ man or woman who has tried less invasive treatment with unsatisfactory results.

When the following conservative treatments have not helped or cannot be indefinitely continued:

• Splinting or bracing of the wrist.
• Over the counter anti-inflammatory and pain medications such as NSAIDs if they are safe for the patient.
• Changing jobs or modifying movements to slow progression of carpal tunnel.
• Corticosteriod injections for temporary relief.

If pain, numbness or weakness continue despite the above treatments, carpal tunnel surgery is typically recommended. Individuals who are already noticing wasting of the muscles or persistent numbness should consider surgery sooner rather than later, so that they may benefit from hand surgery to correct carpal tunnel.

Surgery can provide a solution to carpal tunnel syndrome and limited movement and help prevent irreversible damage.

Risks and Recovery

Carpal tunnel surgery is typically very safe. As with all surgical procedures, there are certain risks associated with the procedure. Rare complications include bleeding, infection and nerve injury are potential risks.

Bergen County plastic surgeons specializing in hand surgery will only recommend surgery if it will provide benefits that should greatly outweigh any risks. In addition, the likelihood of complications is minimized with expert surgical technique and superior patient care.

Patients undergoing surgery for carpal tunnel problems generally recover quite quickly. Immediately after surgery, patients should elevate the hand above the heart, moving fingers often to decrease swelling and help to prevent stiffness. Patients may use their hands normally with care to avoid excessive exertion/heavy gripping so as to diminish pain. In general, patients do not need to wear a wrist brace after surgery.

Minor palm soreness and hand weakness may be present for several months after surgery. The average New Jersey carpal tunnel patient will see their grip strength and pinching/grasping ability significantly improve about 3-6 weeks after carpal tunnel surgery.

Choosing the Right Surgeon

Dr. Janet Yueh is dedicated to helping carpal tunnel patents improve their lives with top-notch surgical skill, years of experience and both functional and aesthetic awareness that allows them to produce excellent results. She meets daily with patients in their Bergen County office to discuss the goals of surgery in each case and provide expert advice.

The surgeons partner with each patient who can benefit from carpal tunnel surgery throughout the procedure and recovery period, to provide the best possible outcome. Our goal at Cohen/Winters Aesthetic & Reconstructive Surgery is to deliver personalized surgical care tailored to the unique anatomical needs and personal goals or each patient.