Carpal tunnel release is surgery to relieve pressure on the median nerve.
Pressure on the median nerve causes
carpal tunnel syndrome
. This may occur when people use their hands and wrists repeatedly in the same way. It also may occur as the result of certain illnesses, such as
rheumatoid arthritis
.
The median nerve passes through the wrist, to the hand through the carpal tunnel. The carpal tunnel is made up of the bones of the wrist and a ligament called the transverse carpal ligament. Swelling due to injury or fluid changes, or hereditary narrow tunnel can cause increased pressure on the median nerve. This results in numbness and tingling in the thumb, index finger, middle finger, and part of the fourth finger. It also causes a weakening of the hand's grasp. This is known as carpal tunnel syndrome.
Surgery to treat carpal tunnel syndrome is usually recommended in the following instances:
Other therapies have failed, including icing, splints or braces, anti-inflammatory medications, steroid injections, physical therapy, or ultrasound
There is shrinkage (atrophy) and weakness of the muscles controlling the thumb
Studies of nerve functioning show the median nerve is not working properly
Risk Factors for Complications During the Procedure
You and your doctor will discuss the use of
general anesthesia or local anesthesia with sedation.
Description of the Procedure
Carpal tunnel release may be done with a classic open incision or with the newer endoscopic techniques.
Open Carpal Tunnel Release
The surgeon makes a 3-5 inch incision in the lower palm and wrist area. He then opens the carpal ligament and frees the median nerve. The incision is closed with stitches. A bulky bandage is applied to the wound.
Endoscopic Carpal Tunnel Release
A tiny, ½-inch incision is made on the palm side of the wrist. A miniature fiberoptic camera is passed through. This camera allows the surgeon to view the inside of the carpal tunnel on a monitor in the operating room. Another tiny incision is made, into which surgical instruments are passed. While looking at the monitor, these instruments are used to release the carpal ligament and free the median nerve. After the camera and instruments are removed, a few stitches are necessary to close the incisions. A bulky bandage is placed over the wounds.
Your hand and wrist will be wrapped in a bulky bandage and elevated to control swelling. Ice packs may be applied periodically.
How Long Will It Take?
The procedure takes about
15-60 minutes.
Will It Hurt?
Anesthesia prevents pain during the procedure. Once the anesthesia wears off you will experience some pain and tenderness in the area of the incision(s).
Possible Complications
If there are any problems during the endoscopic procedure, the surgeon may need to change to the traditional open procedure.
Some complications include:
Infection
Bleeding
Swelling
Nerve damage
Stiffness of the fingers
Continued numbness, tingling, weakness, or pain
Average Hospital Stay
A hospital stay is not required.
Postoperative Care
Keep your hand elevated as much as possible for several days to decrease swelling and pain.
Apply an ice pack to your wrist and hand for 20 minutes at a time, every 3-4 hours over the first couple of days after your procedure.
If your bandage becomes soiled, your surgeon may advise you to change it or may ask you to see him or her.
Do not lift heavy things or strain the hand and arm until you are advised that you may do so by your surgeon.
Return to your surgeon in 7-10 days to have the stitches removed.
Follow the exercise program recommended by your surgeon once you've begun to heal.
Arrange to have help around the house, especially if you've had both hands operated on.
Many cases of carpal tunnel syndrome are believed to occur due to repetitive actions (often occupational injury). Check with your doctor about how to prevent a recurrence.
Outcome
You may have to wear a brace or splint for several weeks after surgery.
Complete recovery may take four weeks or longer. But usually rather quickly, the numbness or tingling in your hand and fingers will improve. Your grasp strength will very slowly begin to improve. You may be given special exercises or be advised to attend physical therapy to further improve the strength and mobility of your hand and fingers.
Call Your Doctor If Any of the Following Occurs
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
Nausea and/or vomiting that you can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
Signs of infection, which include fever, chills, or increased pain
Pain that you can't control with the medications you've been given
Increased tingling or weakness in your hand
Cough, shortness of breath, or chest pain
RESOURCES:
American Academy of Orthopedic Surgeons http://www.aaos.org
Familydoctor.org http://familydoctor.org
CANADIAN RESOURCES:
Canadian Orthopaedic Association http://www.coa-aco.org/
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
