What
is
Carpal Tunnel Syndrome?

If you have “classic” carpal tunnel syndrome, your symptoms are:

• Tingling and numbness in your thumb, index and middle finger.
• Aching in the forearm which can radiate to the shoulder and clumsiness or weak grip.

Not everyone shows classic, textbook carpal tunnel symptoms – you may be one of these. Instead, you may have:

• Tingling in all fingers
• Tingling only in the thumb or the middle finger
• Aching and pain in the hand
• Radiating pain to the shoulder or back.

Think of the carpal tunnel as exactly that – a tunnel inside your hand. This tunnel is formed by a semi-circle of carpal bones on three sides. The fourth side of the tunnel is the transverse carpal ligament. This ligament cannot stretch.

So the carpal tunnel is a defined space that cannot enlarge. There is only so much room in the tunnel. This roominess is critical to good hand health. Through the tunnel’s opening passes the median nerve, nine tendons, and spongy tissue around the tendons called tenosynovium. We start our lives with extra space in the tunnel.

The tenosynovium swells for a number or reasons – when you run out of extra space because of this swelling, then pressure is placed on the median nerve. You develop carpal tunnel symptoms. There is no longer enough room for everything to fit comfortably inside the carpal tunnel. So you’re suffering.

At The Brown Hand Center, our treatment of carpal tunnel syndrome is not just to reduce pressure on the nerve so that your symptoms are tolerable, so you can live with it. Instead, the goal is to relieve the pressure entirely, reduce the chance of permanent nerve damage – and offer you an entirely comfortable, entirely safe experience.

The Anatomoy
of
Carpal Tunnel Syndrome

Carpal tunnel syndrome – CTS – symptoms were first described by Sir James Paget in 1863. The pathologic changes in the median nerve were noted by Marie et Foix in 1913. The term “carpal tunnel syndrome” was coined by Moersch in 1938.

The “open” carpal tunnel release operation was first performed in 1947 by Wright, Brain, and Wilkerson. Phalen brought attention to CTS in articles beginning in 1950s. Until the pioneering work by Michael G. Brown, M.D., there was no significant change in the surgical treatment of CTS for nearly 50 years, even though carpal tunnel release is thought to be the most commonly performed surgical procedure in the world. However, the open carpal tunnel procedure, while effective, is fraught with problems:

1. Post-operative pain, from the open incisions, can persist for weeks, months or permanently. Doctors and patients have often opted for anti-inflammatory medication or steroid injections for fear of the post-operative problems associated with “open” carpal tunnel release. Unfortunately these treatments are usually ineffective or only provide temporary relief, delaying the inevitable surgical treatment.
2. By the time the patient finally has surgical release of the carpal tunnel, there is often permanent damage to the nerve from longstanding CTS which results in permanent loss of sensation and possible loss of thumb function.
3. There are additional risks of steroid injection: injury to the nerve upon injection, permanent loss of skin pigmentation and loss of soft tissue under the skin.

A host of “gimmick” treatments and preventions have further confused the public.

Finally, in 1990, 43 years after the first open carpal tunnel release was performed, Michael G. Brown, M.D., developed the minimally invasive endoscopic (“from the inside”) carpal tunnel release (the Brown Procedure). He holds United States patents on the Brown Procedure; as well as the surgical instruments he developed especially to perform the procedure. (With respect to the technique’s safety or results, there are other endoscopic carpal tunnel procedures that are not the same as the Brown Procedure.)

Patients have the Brown Procedure done in a short time and return to work the following day. They can remove the dressing themselves in seven days and resume normal activities. The most important benefits are reduced patient pain and suffering as well as reduced risk of permanent nerve injury from delaying treatment.

This is drastically different from the experience with “open” carpal tunnel release. Patients, employers and insurance carriers benefit from the Brown Procedure by avoiding:

• The cost of ineffective, so-called “conservative” non-operative treatments
• The cost of therapy
• Long delays in returning to work.

Thousands of Brown Procedures have been performed safely and successfully at The Brown Hand Center, bringing long-term relief without drawbacks.

A landmark medical journal article, “A 12-Year Experience Using the Brown Two-Portal Endoscopic Procedure of Transverse Carpal Tunnel Ligament Release in 14,722 Patients: Defining a New Paradigm in the Treatment of Carpal Tunnel Release,” chronicles the work at The Hand Center.