
	Medical Edge


	About

	Television

	Radio

	Newspaper

		Participating Newspapers

	Magazine

	Contact


	About Mayo Clinic

	Make an Appointment at Mayo Clinic

Medical Edge Newspaper Column from Mayo Clinic

CORRECTING CARPAL TUNNEL SYNDROME

DEAR MAYO CLINIC: I’ve heard there’s a less invasive surgery for carpal tunnel syndrome that’s better than the traditional surgery. Is this true? Are there any other treatment options on the horizon?

ANSWER: The carpal tunnel is a narrow passageway on the palm side of the wrist. It contains the main (“median”) nerve to the hand, along with nine tendons that bend the fingers and thumb.

Carpal tunnel syndrome occurs when the thickening, swelling or inflammation of these tissues presses the median nerve against the carpal ligament that forms the roof of the tunnel. This condition may be caused by repetitive, forceful and awkward or stressed motions of the hands and wrists, or by diseases such as rheumatoid arthritis or diabetes. It produces hand numbness, pain and, if left untreated, weakness.

Carpal tunnel syndrome can be treated by nonsurgical options that include physical therapy, over-the-counter drugs for reducing inflammation and pain, or splinting to prevent the wrist from flexing. Cortisone injections are another treatment. Although these options may relieve symptoms, most of the time they are only temporary solutions. Sooner or later, the patient will need to get the carpal tunnel syndrome corrected, and surgery is the definitive treatment.

The traditional surgical procedure, called full-open release, involves an incision up to two inches long in the wrist. This exposes the carpal ligament, which is then severed in order to relieve the pressure on the nerve. The ligament will eventually heal. The tunnel will then have expanded, preventing the median nerve from being compressed.

The procedure you cite, called endoscopic release, accomplishes the same goal but with minimal invasiveness. An endoscope, a telescope-like device with a tiny video camera, allows the doctor to see inside the carpal tunnel and perform the surgery through two small (about one-third-inch long) incisions in the hand or wrist. Patients generally have less pain and heal faster after an endoscopic procedure.

But a controversy has been raging ever since the introduction of endoscopic release in the early 1990s, when surgeons initially had some difficulty with this new technique and nerve injuries occasionally happened. Although every new method involves a “learning curve,” this particular method appears to have since been deemed by some as inherently unsafe. My own perspective, however, is that a skilled endoscopic surgeon can accomplish the objective just as safely and reliably with the less-invasive procedure.

There is a third surgical option, called limited-open release, which uses a smaller incision but is otherwise similar to the open procedure.

Thus there are three surgical options for carpal tunnel syndrome, and the one pursued in any particular case depends on surgeon — and patient — preference. The eight hand surgeons at Mayo Clinic, for example, each favor and recommend different techniques.

— Robert D. Beckenbaugh, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Carpal Tunnel Syndrome
Appointment Information
More Information on Carpal Tunnel Syndrome

READERS: If cancer seems all too common in your family, should you have a genetic test to learn more about your risk?

While genetic tests offer a glimpse of what the future may hold for your health, they have limitations. Genetic tests can’t tell you with certainty whether you’ll develop a disease or how severe it might be if you do develop it. They can only tell you if you have a mutation that has been shown to be associated with a risk of the disease.

Deciding to have genetic testing is complicated. That’s why it’s often recommended to consult a genetic counselor first. Mayo Clinic Women’s HealthSource offers ways a genetic counselor can help:

— Provide information on the benefits, risks and limitations of a specific genetic test.

— Help research your family history and medical records to assess your risk of a genetic disorder or the likelihood that you carry a genetic mutation.

— Explain the implications of a positive, negative or indeterminate test result, for both you and your family.

— Consider possible treatment options or preventive measures if a gene mutation is found.

Costs for genetic tests range from less than $100 to several thousand dollars. These tests may not be covered by insurance. Fortunately, many states have enacted laws that prohibit using genetic test information to determine eligibility for health insurance.

Additional Resources:
Genetic Testing
More Information on Genetic Testing

- - -

Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.