Carpal tunnel syndrome is a common disorder in which the median nerve is compressed in a structure called the carpal tunnel, which is found in the wrist. This can be one cause of pain, tingling and numbness in hand. The condition can progress to the point where a person can’t use that hand to pick up everyday objects. Many cases of carpal tunnel syndrome can be eased by conservative methods, but if these fail, the patient can opt for a surgery called carpal tunnel release.
Before the Surgery
Carpal tunnel release open surgery is decided upon after a consultation with a doctor who takes the patient’s medical history and performs a thorough exam. The patient asks questions about the surgery, and also lets the surgeon know if they are taking medications, vitamins, herbal supplements or anything else that can affect the outcome of the surgery. The doctor may also order additional tests such as an X-ray of the patient’s hand and EMG/nerve conduction studies which measure how the muscles and nerves react to electrical impulses.
Carpal tunnel release is often an outpatient surgery, which means that the patient can go home to recuperate shortly after the surgery is over.
The patient fasts the night before the surgery and meets with their surgeon and the anesthesiologist at the medical facility the next morning.
The Surgery
During the surgery, the patient is sedated or sleeping, and the patient’s hand is numbed by a local anesthesia. The doctor marks the area on the hand, and then places a tourniquet around the arm to visualize the surgical site clearly. An incision is then made at the bottom of the hand. The doctor may cauterize blood vessels to prevent excessive bleeding.
The surgeon uses retractors to expose the fascia, which is the white membrane just below the skin. The fascia is cut to expose the transverse carpal ligament, which is what
is impinging on the median nerve. The surgeon cuts this ligament and releases the nerve.
After this, the surgeon closes the surgical wound with fine stitches which are usually removed about 14 days after the operation. If the stitches are absorbable, they are not removed. The doctor then applies a dressing to the patient’s wrist. The doctor doesn’t suture the place where they cut the ligament but allows scar tissue to fill it.
Recovery
The fingers of the hand may be swollen the day after the surgery, and some people feel pain when they put pressure on their thumb. Again, the discomfort can be relieved with icing, elevation and pain medications. The bandage needs to be kept dry, so the patient needs to put a plastic bag over their hand when they shower.
Dressings come off after a few days. The doctor recommends that the patient not do anything strenuous with that hand initially. A person whose job requires repetitive hand movements such as typing may need several weeks to recover if they had surgery on their dominant hand. Patients who work with both hands or have a strenuous job may require additional time to recover.
Patients who have carpal tunnel release should prepare their home beforehand for their recovery. First, they need someone to drive them home after the surgery and to possibly help them at home. One tip is to buy any pain medications before the surgery.
It will be difficult for the patient to open bottles, jars and containers for a while, especially if their dominant hand was operated on. Meals that have been prepared ahead of time that can be warmed in the oven or microwave are a good idea. The surgery is even a good excuse to eat out.
Most people who have carpal tunnel release find that their carpal tunnel symptoms are completely resolved.
Posted in: Hand Surgery, Reconstructive Surgeries