CPT Code: 64721
What is carpal tunnel syndrome?
The word “carpal” refers to the wrist, so the carpal tunnel is the wrist tunnel. This tunnel is formed by bone on the back and sides, and a thick ligament on the front (in the palm). Through this tunnel pass the 9 tendons that move the fingers and a nerve—the median nerve—that provides sensation in the thumb, index finger, long finger, and part of the ring finger. Because all these structures are confined to this relatively small space, any swelling in the carpal tunnel can cause pressure on the median nerve, which can cause it to “go to sleep” and, if the compression is severe and longstanding, result in permanent nerve damage.
The typical symptoms of carpal tunnel syndrome are numbness and tingling in the thumb, index finger, long finger, and ring finger. These words are often used interchangeably, but in this case “numbness” refers to a loss of sensation in the fingertips, and “tingling” refers to the feeling that the fingers are asleep, or that ants are crawling on the skin. When the median nerve (or any nerve) is compressed, it loses blood flow, causing tingling (think of when you sit awkwardly and your foot falls asleep). If the compression is bad enough, the nerve fibers will not work properly, causing numbness.
These symptoms are usually worse at night, for two reasons: (1) we tend to flex our wrists when we sleep (as when tucking our hand under our pillow), which creates more pressure on the median nerve in the carpal tunnel; and (2) our hands and wrists swell a bit when we are sleeping (as opposed to when we are upright during the day, when our feet and ankles swell).
Other symptoms of carpal tunnel syndrome are dull/aching wrist pain, stiffness of the fingers, hand weakness, and, in severe cases, atrophy (flattening) of the muscles in the palm at the base of the thumb.
How do we treat carpal tunnel syndrome?
One of the first things to try is a nighttime wrist brace to keep you from bending your wrists when you sleep. If your symptoms occur at work, try to keep your wrists in a relaxed, straight position. Anti-inflammatory medications, like ibuprofen or naproxen, can sometimes help. Some people benefit from stretching exercises, as with yoga.
If none of these things helps, and your symptoms are occurring frequently (nightly or nearly nightly), you should see a hand surgeon. One option he/she might provide is a steroid injection in the carpal tunnel. This can reduce the swelling around the nerve and relieve the symptoms. However, this is not a permanent cure, as the steroid wears off after a few months. The next step is surgery (carpal tunnel release), which does provide a permanent cure for carpal tunnel syndrome.
What is carpal tunnel release?
Remember that the carpal tunnel is formed by bone on three sides and a thick ligament in the palm. During a carpal tunnel release, this ligament is cut, allowing the carpal tunnel to spring open slightly, relieving pressure on the median nerve. This immediately eliminates the tingling (once the anesthetic wears off), as the blood flow to the nerve is now normal. If there was no significant nerve damage, the numbness will also go away, although in longstanding cases of carpal tunnel syndrome the numbness can persist for quite a while. If there was significant nerve damage, the nerve may never return to normal.
There are different ways to cut the ligament to release the carpal tunnel. Some surgeons use an endoscope, which is a small camera that is inserted into the carpal tunnel, so that the ligament can be cut from the inside. This requires a ½-inch incision in the wrist crease. This procedure is done in a surgery center or hospital and requires sedation or general anesthesia.
Our preference is to make a 1-inch incision in the palm over the ligament and cut the ligament directly, under direct vision. This can be done very comfortably with only a local anesthetic. Although the incision is slightly longer, we think this is a little safer than the endoscopic approach, and much less expensive, since there is no need for anesthesia. Medical conditions that make general anesthesia more risky are also usually not an issue with office-based, local anesthetic procedures. The procedure takes about 10 minutes, and you can even drive yourself home!
What is the recovery from carpal tunnel release?
Recovery is pretty easy. You will leave the office with a sterile bandage, which you can remove the next day. You can wash your hand in the shower or sink with clean, soapy water, but avoid dirty water for a couple weeks. You can move your fingers all you want, but avoid lifting anything more than a couple pounds for two weeks. At two weeks, the skin stitches will be removed, and at that point you can return to normal activities with no restrictions. You will notice some soreness over the incision for about 2 months, but that will gradually dissipate.
Texas Free Market Surgery’s Bundle
What is included
Postop Visit(s)* (if applicable)
Durable Medical Equipment (crutches, splints)*
*Our goal is to include as much of care in our price. Though, there are certain things that are not included. Please see our pricing details page. Don’t hesitate to reach if you have any questions on what is and is not included!
What is not included
**While we do not include the cost of hardware or implants, we provide an invoice of this cost prior to the surgery at cost- we do not mark the cost of implantables.
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