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Carpal Tunnel Release Surgery: Affordable Cost… Best Treatment

Carpal Tunnel Syndrome Surgery in India

What is Carpal Tunnel Release Surgery?

Carpal tunnel release” is the surgical procedure performed for the treatment of Carpal tunnel syndrome to relieve the pressure on the median nerve. This widens the tunnel, creates more space for the nerve and thus releases the pressure on the nerve. The procedure can be performed using two different techniques open carpal tunnel release or endoscopic carpal tunnel release. In both the procedures the transverse carpal ligament that covers the tunnel is cut and both are aimed at relieving the pressure on the median nerve.

Causes carpal tunnel syndrome:

Carpal tunnel is a narrow passage, about an inch wide, surrounded by wrist bones. A nerve called median nerve passes through this tunnel. The nine tendons called flexor tendons also travel through the carpal tunnel. The nerve and the tendons are responsible for bending of fingers, index, middle and ring finger and thumb. The muscles at the base of the thumb are also controlled by these nerves. The covering of the tunnel is formed by string band of connective tissue and because of the stiff nature of the tissue it does not stretch much. Thus, the tunnel helps in protecting the nerve. Sometimes, the carpal tunnel gets narrowed or there is swelling of the tissue that surrounds the flexor tendon. This creates pressure on the median nerve causing symptoms of carpal tunnel syndrome. Certain positions for prolonged period of time and certain repetitive movements of hand can cause the condition.

  • Repetitive movements of wrist like milking cows, continuous use of screw drivers, weeding by hand, turning of keys repetitively (locksmiths), etc.
  • Position of hand causing extension of wrist for prolonged period of time like knitting, using mouse and keyboard, use of spray guns, etc.
  • Continuous use of vibrating hand tool like air-power hand tool
  • Work related stress
  • Anatomical problems in the wrist joint
  • Formation of cyst or tumor the wrist area
  • Inflammation of the tendons
  • Medical conditions like trauma, pregnancy (hormonal changes during pregnancy), obesity, rheumatoid arthritis, diabetes and thyroid gland imbalance indirectly increase the risk of developing carpal tunnel syndrome. 
  • Heredity may also be a risk factor for development of Carpal tunnel syndrome.

Signs and symptoms of carpal tunnel syndrome:

  • Numbness, pain and tingling sensation are the major symptoms of the condition.
  • These symptoms are experienced mainly in index, middle and ring finger and the thumb. Pinky is not involved. 
  • Pain and tingling may radiate to forearm in the direction of shoulder. 
  • Sometimes there is shock-like sensation. 
  • The shock like sensation can radiate to the three fingers and the thumb. 
  • There may be weakness and clumsiness in the hand and inability to perform fine movements like buttoning the clothes. 
  • There may be loss of awareness of position of hand in space. This is called proprioception. 
  • Weakness, numbness and proprioception may lead to loss of grip. 

 

In most patients with this condition the symptoms develop gradually over a period of time and in the initial stage they may be mild and on and off. As the condition progresses the symptoms may be severe, more frequent and may persist for longer period of time. Generally activities involving bending of wrists initiate the symptoms. 

Diagnosis of carpal tunnel syndrome:

Diagnosis of the condition is made on the basis of 

  • Physical examination 
  • Nerve condition studies
  • Electromyogram
  • Ultrasound
  • X-rays
  • Magnetic resonance imaging (MRI) studies
  • Blood testsfor underlying conditions like tests for diabetes, rheumatoid arthritis, and thyroid function

Types of Disease and stages

Carpal tunnel syndrome is an orthopaedic condition. An orthopaedic surgeon, a plastic surgeon or a neurosurgeon performs the surgical treatment for the condition. The stages may be initial stage and advanced stage.

Treatment of carpal tunnel syndrome:

There are surgical and non-surgical treatment options for treatment of carpal tunnel syndrome.If the condition is diagnosed in initial stage then non-surgical treatment can relieve the symptoms. 

  • The non-surgical treatments include use of brace or splint, non-steroidal anti-inflammatory drugs, activity changes, steroid injections, and nerve gliding exercises. If the condition is secondary to other medical condition then treatment for that condition may relieve the wrist symptoms. For example, if Carpal tunnel syndrome is secondary to rheumatoid arthritis or obesity then treatment for these conditions is helpful.
  • Lifestyle changes: if the symptoms are due to jobs that involves keeping it extended for prolonged period of time or repetitive movements some changes can be made while doing these jobs works like frequent breaks or muscle strengthening exercise.
  • Immobilization: Use of braces or splints helps to keep the wrist straight or in neutral position. This helps to relieve the pressure on the median nerve. They can be used during night as well as day time depending on requirements. 
  • Medications: The non-steroidal drugs like ibuprofen and naproxen help in relieving inflammation and pain. A steroid injected directly in the carpal tunnel may help in relieving the symptoms. These are highly active anti-inflammatory drugs and can relieve symptoms but their effect is mostly temporary. This injection may also be used for diagnosis of the condition. 
  • Exercises: Nerve gliding exercises may also be helpful in reliving the symptoms of carpal tunnel syndrome. This allows more free movement of the median nerve inside the tunnel. Occupational and physical therapies may also be useful. The doctor or the physiotherapist is the right person to recommend the specific exercises.  
  • Alternative medicine: alternative or complementary medicine, yoga, acupuncture and ultrasound therapy are some of the alternate treatments for carpal tunnel syndrome. 
  • Surgery: If non-surgical treatments do not work then surgery is the treatment. 

Surgical Treatment For Carpal Tunnel Syndrome:

If non-surgical treatment fails to improve the symptoms then surgical treatment is the option. Having constant numbness and wasting of thumb muscles can cause irreversible damage to the median nerve. If pressure on this nerve is not taken off it can cause nerve damage. Surgery can prevent the damage. The decision of surgical treatment depends on the severity of symptoms. 

 

In most patients the surgery is carried out on outpatient basis. This means the patient is discharged after the surgery or on the same day; hospital stay is not required. Anaesthesia may be local or general. In local anaesthesia only hand and arm becomes numb. In general anaesthesia patient is asleep during the procedure. In some cases light sedative may be given to the patient. 

Carpal Tunnel Syndrome Surgical procedure:

Carpal tunnel release is the name of the surgical procedure performed. This can be done in two different ways open carpal tunnel release or endoscopic carpal tunnel release. 

  • Open surgery: In this a cut of about 2 inch long is made on the palm of the hand. This is called incision. Doctor can view inside the wrist through this cut. The doctor then divides the ligament along the roof of the tunnel called transverse carpal ligament through this cut. This expands the tunnel and relieves the pressure on the median nerve. After surgery growth of the ligament takes place but there will be still more space inside the carpal tunnel, thus pressure on the nerve remains relieved. 
  • Endoscopic surgery: In case of endoscopic carpal tunnel release surgery one or two smaller incisions are made, about half inch each. They are called portals. A small camera called endoscope is inserted through one portal to see inside the wrist. A special knife is used for this. This is passed through the other portal. Here also doctor divides the transverse carpal ligament as in case of open surgery. As the cuts are smaller in this procedure they heal faster and cause less pain.

 

The results of both the surgeries are similar. Each procedure has its own advantages. The selection of procedure depends on the condition and the doctor explains it to the patient. 

Complications of carpal tunnel syndrome Treatments:

As there can be complications with any other surgery carpal tunnel release surgery can also cause complications like bleeding, infection and nerve aggravation or injury. Certainly, doctors take utmost care to completely avoid or minimize them. 

Outcome:

Outcome of the surgery is excellent in most patients. In most patients symptoms improvesoon after surgery. However, recovery may take longer time. It depends on severity of condition, patient’s age, general health and time period of symptoms. It may take several months to one year for complete recovery. There are conditions in which recovery may be slow like arthritis, tendonitis and long standing cases of carpal tunnel syndrome in which there is severe loss of sensation and wasting of muscle around the thumb base. Recovery may be partial in such patients. 

 

Though very rare the condition, carpal tunnel syndrome may reoccur. In such cases additional treatment or surgery is possible.  

Am I a Good Candidate for treatment/surgery?

If the symptoms are severe or the non-surgical treatment like lifestyle changes, immobilization, medications, and alternate therapies are not useful then definitely you are the perfect candidate for carpal tunnel syndrome surgery. Also if the muscles of your hand and wrist have become weak due to worsening of the condition then also surgical treatment can reverse your condition.

Recovery time of Carpal Tunnel Syndrome Treatments:

There will be some pain, stiffness and swelling after the surgery and this is perfectly normal. Minor pain and discomfort may be there in the palm for few weeks to few months. After surgery generally it takes 2-3 months to get grip and pinch strength.If condition of median nerve is poor before surgery case then it can take 6-12 months.

Aftercare

  • After the operation dressing will be there at the site of incision. 
  • Take post-operative care for wound healing.
  • Keep the stitches and the skin around dry.
  • Use the wrist brace or splintfor several weeks after the surgery to avoid hyperextension of the wrist. 
  • Avoid repetitive activities as per the instructions given by the doctor. 
  • Do only light activities that do not distress the palm and hand. Do activities like self-care, driving, light lifting and gripping in some time after the surgery?
  • If there is significant pain and weakness that lasts more than 2 months then hand therapist will help you for speedy recovery.

Success rate of Carpal Tunnel Syndrome Treatments

Success Rate of carpal tunnel surgery in terms of improvement of symptoms is about 90% and little less than 90% patients can do the jobs they were doing previously. You also can join your previous work after surgery.

Benefits of Carpal Tunnel Syndrome Treatments:

Surgery for carpal tunnel syndrome helps in relieving the symptoms and prevents permanent nerve damage.

Cost Comparisons of carpal tunnel syndrome Treatments:

The cost of carpal tunnel syndrome surgery in India is less than 1/20th as that in USA, less than 1/4th as that in Mexico. The cost of this surgery is cheaper in Thailand (approx. ¼.5th of India) and Singapore (approx. 4/5th of India) as compared to India. 

Why Choose MedcureIndia? 

India has highly skilled and professional orthopaedic surgeons’ and world class hospitals. We at MedcureIndia have association with such institutes and work in collaboration with them with the vision to provide best treatment to each patient across the globe at most affordable cost.




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