When should it be considered?
When more conservative treatments have failed to relieve the pain of carpal tunnel syndrome, surgery may be indicated. It is generally recommended that if symptoms persist for four to six months and if muscles begin to atrophy in the base of the palm, the patient may require surgery. The procedure does not cure everyone, and because it permanently cuts the carpal ligament, some wrist strength is often lost.
How to prepare for surgery.
As you prepare for the surgery you should educate yourself about the procedure. Knowing what to expect can ease many fears and make recovery much smoother. If possible, find someone who has had the surgery to talk to.
You will be “one handed” for a while after surgery. Plan for it now. Organize things so that everything is reachable with your “good” hand from all your favorite chairs.
What happens during the surgery?
There are several different surgical procedures used to treat carpal tunnel syndrome. We will discuss the two most common ones.
Open Release Surgery
This has been the traditional procedure for many years. A local anesthetic is injected either into the wrist and hand or higher up the arm, general anesthesia may used in some cases. Once the hand is numb a 2-3 inch incision is made in the palm of the hand, near the wrist. The surgeon then makes an incision in the muscles of the hand until the carpal ligament is visible. The carpal ligament is then cut free from the underlying median nerve. The ligament is literally released and therefore the pressure on the median nerve is relieved. The insision is then stitched closed.
Endoscopic Release Surgery
Newer endoscopic techniques are now allowing surgeons to perform a release surgery without a large incision. One or two 1/2-inch incisions are made in the wrist and palm, and one or two pencil-thin tubes called endoscopes, are inserted. A tiny camera and knife are inserted through the tubes. The camera projects the images of the inside of the wrist onto a TV screen. The doctor then makes the cuts to release the carpal ligament with the mini-knife. Although the success rate has in the past been slightly lower with this procedure, as surgeons gain more experience with this procedure, studies are now reporting similar success and complications rates to standard open surgeries.
What happens after surgery?
Both procedures are typically done as out patient surgery. You will go home the same day. Your hand and arm will be wrapped in a bandage designed to minimize bleeding and swelling. To reduce swelling, it is best to keep the hand elevated at night on two pillows and in a sling for the first five days. In many cases the symptoms present before surgery are immediately relieved.
Some of the normal home-going instructions include:
Do not return to work for 4 weeks, or until okayed by your doctor.
To help rebuild wrist strength, physical therapy is very important. Follow all instructions given by your physical or occupational therapists. Hand exercises can help restore circulation, muscle strength, and joint flexibility in the hand and wrist.
Do not get incision wet until sutures are removed.
Keep the incision clean and dry. If any swelling, increased pain, drainage from the incision site, redness around the incision, or fever is noticed, report this immediately to the doctor.
What is the expected outcome of a
carpal tunnel release?
For some people, the surgery relieves CTS symptoms of numbness and tingling immediately. In one study, grip and pinch strengths were stronger than before surgery within six weeks. Maximum improvement may take a long time; in one study improvement took an average of almost 10 months.
What complications may occur?
In spite of the success of surgery, treatment failure and complication rates range in studies from 3% to 19%. Some of the possible complications are painful scarring, pain as a result reflex sympathetic dystrophy, blood clots, infection, loss of sensation to the index finger and thumb, muscle weakness, and nerve or tendon injury.
For more information:
Well Connected CTS-Copyright � Nidus Information Services 1999
Carpal tunnel syndrome: it’s diagnosis and treatment. Jeffrey S. Malka, M.D., F.A.C.S., F.A.A.O.S
Your Surgery-Carpal Tunnel Release