Carpal tunnel – at the wrist
Cubital tunnel – at the elbow
Pressure may be put on nerves in the wrist and/or elbow due to inflammation resulting from repetitive motion, normal wear and tear due to aging, arthritis, fluid retention, or previous fractures at these sites.
Both syndromes include pain, numbness, and tingling in either or both hands and in all or a few fingers. At the onset, symptoms may be experienced mostly at night. If diagnosis and treatment are delayed, symptoms tend to get worse: pain increases, grip strength weakens, and you may drop things. Early treatment may prevent permanent nerve damage and potential disability.
Your physician will take your history and do a physical examination.
Some questions might include:
Electro-diagnostic tests may be ordered to determine whether a nerve is being pinched. These tests may include: nerve conduction studies, electromyography, and somatosensory sensory evoked potentials. X-rays may be ordered.
Your doctor may order a brace and/or anti-inflammatory medications. If treatment does not help, surgery may be recommended. Early treatment has the best potential for a good outcome. Some things you can do to reduce your risk of carpal tunnel syndrome:
There are two common ways the carpal tunnel release is done.
In addition to the usual risks of any surgery, the potential risks for carpal tunnel release include:
Your doctor will discuss with you any concerns you may have about the surgery and recovery.
Use your pain medication carefully. Many patients have been on a lot of narcotics prior to and after surgery. Using them wisely in your post-operative period will avoid future problems and you will get better pain relief if you do not have an increased tolerance to them.
Let your pain determine your activity level. If something causes increased pain, avoid that activity. To keep your hand flexible as it heals, it is best to begin moving your fingers right after surgery. Certain exercises may be recommended to help maintain circulation in your hand, improve flexibility, and increase your strength.
To protect your healing skin and ligament, avoid bending your wrist very far forward (flexion) or backward (extension).
It is okay to loosen the dressing if it is too tight. The dressing may be removed on the 4th day after surgery.
Within a day or two after surgery, you can begin to use your hand for light activities. Your hand will probably be weak at first, but it will get stronger as you use it. Avoid bumping or hitting the area around the incision(s). In many cases, you will be able to resume driving when you stop taking prescription pain medications, usually in about a week.
You may take a shower, but cover the hand and wrist with plastic or some sort of covering and keep it elevated above the water. It is best not to get the incision wet until after the sutures are removed and you are told by the doctor that you can wash it. DO NOT TAKE A BATH as the incision should not be soaked in water. DO NOT PUT OILS OR OINTMENTS ON THE INCISION SITE. Keep your dressing clean and dry.
For the first several days after your surgery, keep your hand elevated above the level of your heart to reduce swelling and pain. You may notice that the palm and the back of your hand are black and blue for a few days-this is normal and nothing to worry about. If you have discomfort in your wrist or palm, take your pain medications as directed. An ice pack may also help relieve discomfort.
Suture removal/incision check and the six week visit:
Sutures will usually be removed within about 10 days. At that time, an appointment will be made for a 6-week follow-up office visit. You and your doctor can discuss the results of your surgery.
If your carpal tunnel injury was caused by repetitive strain, you may need to make some changes in how you use your hands to avoid future problems. With care, you may regain full use of your hand and remain free from painful symptoms.
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