Surgeons deliver quick recovery for carpal tunnel patients

This story first appeared in Healthy You - July 2024, The Gazette’s quarterly health publication.

Carpal tunnel syndrome can cause persistent pain and discomfort that makes everyday activities a challenge. That enduring pain does not have to linger, according to orthopedic surgeons.

Getting a diagnosis and treatment does not mean additional aggravation either. Surgeons in the Corridor are utilizing less invasive methods that can fix this condition without needing to go under anesthesia.

Carpal tunnel syndrome is one of the most common conditions affecting the hand and wrist that Dr. Thomas Ebinger treats. Ebinger has been practicing with Steindler Orthopedic Clinic in Iowa City for 10 years. He said about 95 percent of his surgeries are hand surgeries.

The condition occurs when a nerve in the wrist is compressed, causing shooting pain, numbness or weakness in the fingers. It is caused by normal use of the hands and wrist, particularly with repetitive motions.

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Diagnosing carpal tunnel has been frequently done with the use of electromyography, a process that involves putting needles or leads on the patient’s arm and sending a current through their nerves to measure how fast that signal is traveling.

The procedure is relatively uncomfortable, Ebinger said. It can also take 30 to 40 minutes.

It has become more common to diagnose carpal tunnel with what Ebinger calls a point-of-care ultrasound. This takes about five to 10 minutes and allows a doctor or nurse practitioner to observe the nerve and check for swelling without using any needles. Often this can be enough to confirm a diagnosis of carpal tunnel syndrome.

“It’s just like looking at a baby. We use some gel and take some measurements,” Ebinger said. “It tells us the severity in a lot of cases. Occasionally you’ll find things that you might not see in a nerve test.”

In most cases a patient can have their hand and wrist looked at under an ultrasound shortly after sharing their symptoms with their physician, rather than needing another appointment.

Dr. Joseph Buckwalter, orthopedic surgeon at the University of Iowa Medical Center, advises that if pain or discomfort in the hand or wrist is persistent, it is best to speak with a doctor and consider treatment. A few factors will determine if surgery is necessary.

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“It depends on the severity and duration of the symptoms or the frequency. How much does this interfere with your daily living?” he said. “If you see a hand provider, the first thing they’re going to ask you is how long this has been going on and who have you seen for it.”

Patients who experienced carpal tunnel syndrome about 20 years ago were likely to be put under general anesthesia and placed on a breathing tube, Ebinger said. An incision would be made from their palm up their forearm. After surgery, they would be fitted with a cast or splint for a couple weeks and would be restricted from using their hand for at least six weeks.

In some cases, patients would be required to spend the night in the hospital after surgery.

Treating carpal tunnel syndrome is a short process with a quicker recovery time now. Buckwalter said surgery is often completed in an hour or two. No narcotic pain medications are required, and patients do not need to be put under.

Ebinger called the anesthesia “wide awake,” meaning the patient is awake and aware throughout the surgery. Some elect to watch the procedure.

They are also allowed to eat and drink on the day of the procedure.

“It’s almost like a dentist appointment. You come in, get a shot to the hand, do the surgery and walk out,” Ebinger said.

The incision in a carpal tunnel release is much smaller than it once was, usually about an inch long at the base of the palm. Patients can use their hand lightly immediately after and are only restricted from heavy gripping for four to six weeks.

Steindler Orthopedic Clinic will soon join the University of Iowa Hospitals in offering endoscopic carpal tunnel releases. Ebinger said a new surgeon who specializes in this surgery will be joining the team at the end of the year.

An endoscopic carpal tunnel release also involves a small incision at the base of the hand, but an endoscope is then inserted to give the surgeon an up-close view.

“Long-term outcomes have shown this to be equivalent to what we often do which is called a mini-open carpal tunnel release,” Ebinger said. “Both are very good procedures. Certain patients like laborers and young people have to get back to their jobs sooner.”

Buckwalter agrees that the ultimate goal for a surgeon is to see their patients back to normal as soon as possible.

“We’re always looking for new ways to treat things and better ways to aid in recovery,” Buckwalter said.