Offices in Berkeley Heights, Livingston, and Morristown, NJ

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Carpal Tunnel Syndrome

Carpal tunnel surgery reduces pressure on the median nerve of the wrist to prevent loss of strength and dexterity.

Overview

Carpal tunnel syndrome (CTS) is a result of pressure on the median nerve of the wrist. The nerve becomes pinched when pressure builds up in the space where the median nerve crosses along with 9 tendons of the hand. It can be on one side, or more commonly, on both sides.

The cause of CTS is unknown, but occupational issues may cause it, and it is known to occur more frequently when patients also have diabetes, rheumatoid arthritis, or thyroid conditions.

If you have pain in one or both hands and wrists, numbness and tingling in the fingers, or loss of strength or feeling in your fingers, you might have carpal tunnel syndrome. The symptoms frequently occur at night, or during activities that require raising of the hands (driving or reading).

At Summit Medical Group, we take a multi-disciplinary approach to CTS treatment. This means that in most cases, we try non-surgical methods before resorting to surgery.

Note that non-surgical and surgical treatments for CTS can only prevent further damage. Whatever strength and dexterity has already been lost cannot be restored. For this reason, it is of vital importance that you do not put off treatment for CTS. Some patients wait for so long that they have little strength left. Then, when they have surgery for CTS, they are disappointed because the procedure was unable to restore them to normalcy. Again, carpal tunnel surgery can only prevent further loss of function, so patients with late-stage disease will get less success out of surgery than patients who don’t let carpal tunnel syndrome destroy their median nerve.

“Dr. Momeni fixed my carpal tunnel syndrome with endoscopic surgery. I drove back to Pennsylvania the next day, 150 miles!”

                         - Patient from RateMDs.com

Your Consultation

Your Carpal Tunnel Syndrome Consultation at Summit Medical Group

When you meet with us for your carpal tunnel syndrome consultation, the first consideration is a proper diagnosis. Before we consider any treatment, an electrical nerve test known as EMG/NCV is done to rule out other nerve problems, such as a pinched nerve in the shoulder or issues with the spine and herniated discs. This test grades the degree of damage to the nerve. Once other issues are eliminated, CTS is diagnosed based on a physical examination and your medical history.

We will have an honest discussion with you about your expectations and concerns, as well as the limits and risks of the treatments we recommend. We will give you written information about your treatments. If surgery is to be performed, we will provide you with instructions to prepare for your surgery, how to take care of yourself after the surgery, and answer any questions you have.

At Summit Medical Group, the patient experience is of primary importance to us. We customize our treatment approach so that it is tailored to what is best for you and you alone.

Hand Surgery

Plastic Surgeons and Hand Surgery

Just like orthopedic surgeons, all plastic surgeons train in the surgery of hand. In fact, historically, the origins of hand surgery involved more plastic surgeons than orthopedic surgeons, but over time, orthopedic surgeons have surpassed plastic surgeons in number in the USA. Some plastic surgeons and some orthopedic surgeons choose to specialize and focus on hand surgery. Not all plastic surgeons and not all orthopedic surgeons specialize in hand surgery. In our practice, Drs. Momeni and Schmid specialize in hand surgery across multiple offices.

What to Expect

What to Expect from Carpal Tunnel Syndrome Treatment

The goal of treatment is to reduce swelling and relieve nerve pressure. Patients who experience early signs and symptoms of carpal tunnel syndrome should first be treated with:

  • A wrist brace while sleeping (not during the day)
  • Changing patterns of hand use (reducing harmful activities and poor positions)
  • Resting periods during work and hobbies (taking 5 minutes’ hand rest every hour)
  • Anti-inflammatory medications for brief periods (Aleve, Motrin, or Advil)
  • Steroid injections (usually no more than once)

Note that physical therapy is not used to treat CTS because in our experience, more exercise would only exacerbate the problem.

If these non-surgical methods do not improve the condition within 3 to 6 months, you run the risk of losing dexterity, function, and strength in your hands, which cannot be repaired. At that time, surgery is indicated.

CTS surgery is an outpatient procedure that takes about 30 minutes. You may choose local anesthesia (awake) or twilight anesthesia (light sedation sleep).

There are two surgical methods: open and endoscopic. Reliable research shows that the long-term results of both types of surgery are the same. The only difference is that most patients say they recover from endoscopic surgery 4 times faster than after open release surgery (worker’s compensation patients are an exception to this research finding). For this reason, we usually plan to perform endoscopic surgery, except for cases where we feel for a specific reason (such as prior hand surgery or significant inflammation), that endoscopic surgery may not be easy to accomplish.

In 1% of patients, endoscopic surgery proves to be impossible (usually due to unusual anatomy). Therefore, in order to release the pressure on the nerve, we must then change our approach and begin open surgery. For that reason, we ask all patients to clear their calendar for a at least 2 weeks of recovery in case we must proceed with open surgery after the incision has been made. (See more about recovery below.) Endoscopic surgery has the advantage of more comfort and faster recovery, but in the long term, the results of both approaches are similar, since they accomplish exactly the same goal in the hand – pressure relief on the median nerve.

The endoscopic technique involves inserting a camera system so that the surgeon can see how to open the tight wrist ligament and relieve the pressure on the nerve. In open surgery, the incision is made in the palm of the hand and is larger than in endoscopic surgery, which can be done with a smaller incision in the wrist.

Your Recovery

Recovering from Carpal Tunnel Syndrome Surgery

There are almost no restrictions that we impose after carpal tunnel surgery on your activities. The exceptions are activities that may cause an infection, such as contact with dirty material or plunging the hands under water early after surgery).

As mentioned above, patients usually report that they are able to return to their daily activities within 7 to 10 days after endoscopic carpel tunnel surgery, while it takes about a month after open surgery on average. Most patients return to work after 2 weeks or less. Since patients’ subjective experience of discomfort can vary widely, the time you’ll need for recovery depends largely on your own comfort level.

Again, there are few restrictions placed on patients after either type of surgery. This means that your surgeon will not require that you avoid any particular activities. You will likely experience limitations in mobility and flexibility, however, which will prevent you from performing some activities until healing has taken place. Still, you can try whatever you like, within reason. If it is comfortable, you can do it. If it isn’t, you must wait until you heal further.

A simple gauze wrap bandage is placed after the surgery and can be removed by the patient the next day. You can then shower. The endoscopic sutures will dissolve on their own. For open surgery, we have the sutures removed 2 weeks after surgery.

Routinely, two weeks of hand therapy is recommended to help regain motion and build strength. Our office staff can help make the arrangements for these visits after your operation.

The majority of patients (more than 90%) experience some post-surgical discomfort with activities for 2 to 3 months, which gradually improves. The pain in the first few days might require medication, which we prescribe after surgery. Numbness and tingling continues to some degree for up to a year, but they are expected to gradually diminish. At one year, you will know the full extent of improvement, once the nerve has had a chance to recover and regenerate. Many patients will be completely without symptoms. Others might have to live with a small amount of tingling at the fingertip or occasional shooting pain, which are a sign that the nerve was somewhat damaged prior to surgery beyond its full ability to recover after surgery.

A small percentage of patients after any hand surgery may have excessive pain in the treated area, out of proportion to the appearance of the hand. This is sometimes called “flare syndrome” or “pillar pain.” Oral medications, cortisone injections, and hand therapy can help to alleviate the condition within 3-4 months. If significant discomfort remains after 3 months, please call us for an evaluation.

Ninety percent of patients rate their carpal tunnel syndrome treatment as very effective. The remaining 10% are those who waited too long to receive treatment so that the nerve was irreparably damaged.

Doctors

Momeni, Reza

Dr. Momeni

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Pyo, Daniel J.

Dr. Pyo

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Schmid, Daniel , B.

Dr. Schmid

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Testimonials

“Dr. Momeni fixed my carpal tunnel syndrome with endoscopic surgery. I drove back to Pennsylvania the next day, 150 miles!”

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