The Maine Hand Center at Plastic + Hand

Regarding the carpal tunnel anatomy, the carpal tunnel is a narrow space inside the wrist. It is ringed by the carpal bones of the wrist and the overlying transverse carpal ligament. A major nerve, called the median nerve, passes through the carpal tunnel from the forearm into the hand. In a healthy wrist, there is room for the median nerve to pass through without being squeezed.

In carpal tunnel syndrome (CTS), the tendons in the carpal tunnel thicken and swell, crowding the median nerve. If the median nerve gets pinched or compressed, patients can experience numbness and tingling in the affected (thumb, index, middle) fingers, hand pain, and muscle weakness in the thumb.

Some patients might first experience carpal tunnel syndrome symptoms only at night. Soon, these same patients may notice this discomfort throughout the day. It is common for carpal tunnel pain to come and go and it often gets worse over time, leading patients to seek effective carpal tunnel pain relief.

While most people experience carpal tunnel syndrome as a diagnosis that requires long-term and permanent treatment, there are outliers. For example, pregnant women can get this condition from fluid build-up and treat it with a splint or brace, and may not need follow-up care after childbirth.

At the Maine Hand Center at Plastic + Hand, we start this process by listening. We ask patients about their symptoms and what is bothering them in their hands.

While some patients assume that they have carpal tunnel syndrome, they may potentially have other hand ailments like osteoarthritis or tendonitis, making the physical exam essential for proper carpal tunnel syndrome diagnosis. This exam is often paired with imaging tests (i.e., X-rays) or nerve tests (i.e., Electromyography (EMG) or Nerve Conduction Study (NCS) to determine the appropriate carpal tunnel syndrome treatment.

Carpal tunnel syndrome can be successfully treated if it’s treated before nerve damage becomes permanent. For most people, if you have carpal tunnel syndrome, the solution is carpal tunnel release surgery.

Many people seek carpal tunnel relief through splinting, but this is not a sustainable solution. If you have long-term nerve compression, you can risk the nerve dying, resulting in permanent numbness, pain, and weakness. If you have carpal tunnel syndrome, the longer you let it go untreated, you will have a higher likelihood of permanent nerve damage.

Carpal tunnel release surgery relieves pressure on your median nerve and reduces pain and numbness through releasing (cutting) the transverse carpal ligament. This is all done successfully in the comfort of our accredited outpatient Plastic + Hand Surgery Center located on-site here in Portland, Maine.

There are two surgical options to treat carpal tunnel syndrome:

Endoscopic carpal tunnel release

What happens in endoscopic carpal tunnel release? During endoscopic carpal tunnel release surgery, your surgeon will make one small incision in the palm. He/she will guide the small endoscope (camera) and surgical tools into the incision. Live video from inside the hand guides the surgeon’s ability to release the transverse carpal ligament.

The actual endoscopic carpal tunnel release surgery takes about 8-10 minutes and is virtually pain-free. Patients will typically have two stitches and a band-aid on the surgical site, and you can move and use your hand afterward right away.

Patients often have mild to moderate bruising or some swelling post-op in the first two weeks. There are no specific restrictions, and you cannot “mess up” the surgery with normal activity. However, it’s recommended that you avoid things like shoveling after surgery, which can feel tender on your palm. After a week or two, you can likely resume all normal activities.

Open carpal tunnel release

In open carpal tunnel release, the surgery is done through one incision in the palm. The surgeon views and operates on the transverse carpal ligament through the incision.

Depending on the severity of your carpal tunnel syndrome and the procedure (open or mini-open) that is best for you, your surgeon will discuss your specific recovery timeline and post-op details.

If patients cannot get carpal tunnel release surgery immediately, the Plastic + Hand surgeon may recommend a steroid shot, medications, or splint-wearing to ease the symptoms temporarily. You will discuss your options directly with the surgeon in your initial consultation.

Yes. While some insurance companies might have specific requirements, this is a straightforward coverage process.

You’ll first discuss your carpal tunnel release surgery with your Plastic + Hand surgeon. During your initial consultation, your surgeon will evaluate your medical history, your hand symptoms, and discuss the most appropriate hand procedure for your diagnosis.

After this personalized consultation, our scheduling and pre-authorization team will work with you and your insurance company to ensure the procedure is covered and scheduled in a timely manner.

After carpal tunnel release surgery, most patients have successfully treated their carpal tunnel syndrome. While most patients do not typically need follow-up hand therapy, Plastic + Hand has fully qualified occupational therapists to address potential concerns.