Carpal Tunnel Release

Carpal tunnel release surgery involves cutting the transverse carpal ligament, which forms the roof of the carpal tunnel, to enlarge the tunnel and reduce pressure on the median nerve. There are two primary types of carpal tunnel release surgery:

1. Open Carpal Tunnel Release Surgery:

   • Procedure: A small incision (about 2 inches) is made in the palm of the hand. The surgeon views and cuts the transverse carpal ligament directly, which increases the size of the carpal tunnel and decreases pressure on the median nerve.
   • Advantages: Direct visualization of the structures in the wrist.
   • Disadvantages: Longer incision may lead to more pain and a longer recovery period.

2. Endoscopic Carpal Tunnel Release Surgery:

   • Procedure: One or two smaller incisions (about 0.5 inches) are made, through which an endoscope (a small camera) and surgical tools are inserted. The surgeon uses the endoscope to see inside the wrist and cut the ligament.
   • Advantages: Smaller incisions often result in less postoperative pain and a quicker recovery.
   • Disadvantages: Requires specialized equipment and surgical expertise.

Carpal tunnel release surgery might be necessary if you experience:

• Persistent Symptoms: Symptoms such as pain, numbness, tingling, or burning sensations in the thumb, index, middle, or ring fingers that do not improve with conservative treatments.
• Functional Impairment: Weakness in the hand, difficulty gripping objects, or performing fine motor tasks.
• Night Symptoms: Symptoms that disrupt sleep, causing you to wake up at night or preventing you from sleeping.
• Ineffectiveness of Non-Surgical Treatments: Lack of improvement after using wrist splints, anti-inflammatory medications, corticosteroid injections, and physical therapy.
• Electrodiagnostic Evidence: Nerve conduction studies showing significant nerve compression.
• Severe or Progressive Symptoms: Advanced cases with severe nerve compression, muscle atrophy, or worsening symptoms over time.
• Impact on Daily Life: Difficulty performing daily activities and work tasks due to pain, numbness, or weakness.
• Risk of Permanent Nerve Damage: Concern about permanent damage to the median nerve if not treated promptly.

While carpal tunnel release surgery is generally safe, potential risks and complications include:

• Infection: Infection at the surgical site, which can usually be treated with antibiotics.
• Nerve or Blood Vessel Damage: Accidental damage to the median nerve or blood vessels in the wrist during surgery.
• Persistent Symptoms: Incomplete relief or recurrence of symptoms, which may require further treatment.
• Scar Tenderness: Pain or tenderness around the scar, which can be managed with pain relief measures and physical therapy.
• Stiffness: Stiffness in the hand and wrist post-surgery, which can be addressed with hand therapy.
• Anesthesia Complications: Risks associated with anesthesia, including allergic reactions or other adverse effects.

Preparation for carpal tunnel release surgery includes several steps:

• Medical Evaluation: Comprehensive evaluation and discussion with your surgeon about your medical history, symptoms, and expectations.
• Preoperative Testing: Blood tests, electrodiagnostic tests (nerve conduction studies), and imaging studies as needed to confirm the diagnosis and plan the surgery.
• Medication Review: Adjusting medications as directed by your doctor, particularly if you are taking blood thinners or other medications that affect bleeding and healing.
• Fasting: Following fasting instructions if general anesthesia or sedation is planned, typically refraining from eating or drinking after midnight on the day of surgery.
• Arranging Help: Planning for assistance with daily activities during the initial recovery period, as you may have limited use of your hand.
• Home Preparation: Setting up your home to accommodate limited hand use, such as preparing meals in advance and ensuring you have easy access to necessary items.

The procedure involves several key steps:

1. Anesthesia: Local anesthesia is commonly used to numb the hand and wrist, though sedation or general anesthesia may be used in some cases.
2. Incision: For open surgery, a small incision is made in the palm. For endoscopic surgery, one or two smaller incisions are made in the wrist and/or palm.
3. Ligament Cutting: The surgeon cuts the transverse carpal ligament to relieve pressure on the median nerve. In open surgery, this is done directly through the incision. In endoscopic surgery, this is done using the endoscope and specialized tools.
4. Closure: The incision(s) are closed with stitches, and the hand is bandaged.

Postoperative care includes:

• Recovery Room: Monitoring in the recovery room until the effects of anesthesia wear off. You will be given instructions on how to care for your hand and what to expect during recovery.
• Pain Management: Pain medication may be prescribed to manage discomfort in the initial days following surgery.
• Wound Care: Keeping the surgical site clean and dry. Follow instructions for bandage changes and incision care to prevent infection.
• Activity Restrictions: Avoiding strenuous activities, heavy lifting, and repetitive wrist motions initially. Gradual return to activities is recommended as healing progresses.
• Physical Therapy: Hand therapy or specific exercises may be recommended to restore strength and flexibility in the hand and wrist. This helps in reducing stiffness and improving function.
• Follow-Up: Regular follow-up appointments with your surgeon to monitor healing and progress. Stitches are typically removed 1-2 weeks after surgery, and your surgeon will assess your recovery and address any concerns.