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Dr. Paul Pace on Carpal Tunnel Syndrome

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Close Up of Hands Typing on Keyboard

I sat down with Dr. Paul D. Pace, one of TSAOG’s board-certified hand and wrist surgeons, to discuss carpal tunnel syndrome and its causes and treatments.


So, what is Carpal tunnel syndrome (CTS)?
Carpal tunnel syndrome is a combination of symptoms in the hand and wrist that result from increased pressure on the median nerve of your wrist usually from inflamed tendons.

What causes CTS?
Repetitive activity, such as typing or other similar activities can cause tendonitis (or inflamed tendons).  This tendonitis creates pressure on the median nerve in the wrist and this causes symptoms of carpal tunnel syndrome to develop.

What are the symptoms of CTS?
Symptoms of carpal tunnel syndrome include numbness in the hand and pain in the hand and forearm, often present at night, that may wake you up from sleep.  If these symptoms wake you up at night more than once or twice, you should contact a physician.

Does CTS treatment always require surgery?
Absolutely not.  Though surgery may be called for in some cases, carpal tunnel syndrome can often be treated conservatively with excellent results.  The sooner you contact a physician once you begin to experience symptoms, the more likely you can avoid surgery and reverse the process before your symptoms become advanced.

What does conservative treatment for CTS involve?
It would usually involve stretching exercises, performed at home or with a hand therapist, as well as identification and modification of daily activities at home or work that are contributing factors to your symptoms of carpal tunnel syndrome. In addition, a steroid injection can help a great deal to alleviate symptoms.

When should you consider surgery?
You should consider surgery for carpal tunnel syndrome if nerve tests confirm your diagnosis and if your symptoms recur after conservative treatment.

What does surgery for CTS entail?
Carpal tunnel surgery involves making an incision in the wrist and severing the transverse carpal ligament, which is putting increased pressure on the median nerve.  Severing the ligament relieves the pressure on the nerve and, thus, the symptoms of carpal tunnel syndrome resolve.

Do you perform minimally invasive carpal tunnel surgery?
Yes. I perform minimally invasive, though not endoscopic, carpal tunnel release.  I prefer this technique to endoscopic because, in my experience, it offers a recurrence rate of less than 1%, a better result than I’ve found with endoscopic release.  However, if a patient prefers an endoscopic technique, several of my partners at The San Antonio Orthopaedic Group do perform that technique.

If you have to have surgery, what kind of recovery should you expect?
Usually, you would experience significant pain relief within 1-2 days of surgery, a return to light function within 1-2 weeks, and a return to full function within about a month.

How long have you been performing minimally invasive carpal tunnel surgery?
I’ve been performing minimally invasive carpal tunnel release for more than 25 years and, in that time, I’ve completed approximately 20,000 of these procedures.




Dr. Paul D. Pace is a board-certified surgeon, specializing in treatment of conditions of the hand and wrist, with The San Antonio Orthopaedic Group.  He treats patients of any age and his special interests include the prevention and repair of carpal tunnel syndrome as well as arthritis care. To schedule an appointment with Dr. Pace, please call 210.281.9595.


NOTE: We cannot provide medical advice or diagnoses without seeing a patient in person.

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