Keyhole surgery for hand numbness
Nerve compression, particularly carpal tunnel syndrome (compression of the median nerve at the wrist) or cubital tunnel syndrome (compression of the ulnar nerve at the elbow) is a common hand problem.
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These can cause disturbing tingling sensations, numbness or severe pain in the hand and fingers. Symptoms may wake people from sleep or cause them to drop things unexpectedly. If very severe, the hand muscles can become weak and wasted. Treatment depends on how severe the symptoms are and how long they have been present.
In the early stages, they can often be treated without surgery using medication, decreasing the activities that caused them, and with special exercises to loosen the nerves. However, surgery remains the most effective and quickest treatment, especially if they are severe or have been present for many months.
Unfortunately, many patients are afraid of surgery, and not without reason. The most commonly performed surgery is carpal tunnel release or cubital tunnel release with ulnar nerve transposition. Most surgeons make long cuts in the palm (about 3-5cm) or at the elbow (about 8-10cm) to make sure the nerve is fully decompressed. These can leave ugly and sometimes sensitive scars. Full recovery of strength and pain can take several months, and there is a risk of injuring other nerves in the skin causing more pain and numbness.
Keyhole surgery is an advanced technique that uses tiny cuts in the skin measuring less than 1 cm for carpal tunnel syndrome and about 2-3 cm for cubital tunnel syndrome. These are hidden so that scars are almost invisible. A video camera is inserted which allows the nerve to be seen and all structures pressing on it are released with special instruments through the same “keyhole”. It is done under local anaesthesia or sedation as a day surgery procedure.
Studies have shown that keyhole surgery has the same results as open methods and are achieved with less pain, faster recovery and less risk of complications when done by an experienced surgeon. However, as it is difficult to learn, many surgeons may not offer it.
This article was contributed by Dr Andrew Yam, Hand Surgeon, Hand Surgery Associates, Mount Elizabeth Novena Specialist Centre (Singapore) & Parkway East Medical Centre (Singapore).