An Overview of Carpal Tunnel Surgery
Carpal tunnel surgery, also known as
carpal tunnel release, is a procedure that can help relieve pressure on the median nerve to improve symptoms of
carpal tunnel syndrome. This type of surgery involves cutting the tissue around the wrist to alleviate pressure on the median nerve.
Understanding the Carpal Tunnel
The wrist is made up of eight small bones, called "carpal" bones.
The carpal bones connect the bones in your forearm to the bones in your hand -- these are held together by ligaments. The median nerve, which controls some of your hand muscles and allows you to feel sensations with your hand, passes from the forearm to the hand through a confined space in the wrist called the "carpal tunnel." It is much like a tunnel you drive your car through, having a ceiling, floor, walls, an entrance, and exit. The carpal ligament is the tough "ceiling" of the carpal tunnel.
Several tendons also pass through this tunnel. Each one has a special slippery covering, called the "synovium," which allows the tendons to glide smoothly as you move your fingers. In a normal wrist, there is adequate room for both the tendons and the nerve.
The carpal tunnel and the space allowed for the median nerve and tendons cannot get bigger because the bones and ligaments that form the tunnel will not stretch. Therefore, anything that adds to this space will compress the tendons and median nerve. Most often, the synovium around each tendon becomes inflamed and swells. This causes compression of the median nerve and results in painful symptoms.
As the median nerve is squeezed, less blood and nutrients flow to it. Without these essential nutrients, it becomes damaged and is unable to function normally. This causes pain, numbness, and weakness in the fingers and thumb that is often most noticeable at night. The longer the nerve is squeezed, the more the nerve is damaged. This damage can cause scar formation within the nerve, which is irreversible.
Furthermore, if the nerve is compressed for a long period of time, the muscles in the hand that receive signals from the nerve shrink in size due to the lack of stimulation from the nerve. The longer the nerve is compressed, the more severe the muscle loss.
The sooner the pressure on the median nerve is relieved, the better the chance for recovery.
Indications for Carpal Tunnel Surgery
Patients with medical conditions such as
diabetes, hypothyroidism, and
rheumatoid arthritis are more often affected with
carpal tunnel syndrome. It is also more common during pregnancy, after wrist injuries, and in people who perform repetitive tasks with their hands.
The goal of
carpal tunnel release is to relieve pressure on a specific nerve in the wrist, called the median nerve. When the median nerve is compressed, symptoms such as numbness, tingling, and pain (usually in the thumb, index, and middle fingers) begin to develop.
Although there are several non-surgical methods that may help relieve symptoms of
carpal tunnel syndrome, the most effective solution is to perform a carpal tunnel release, which can help minimize symptoms and prevent any further damage to the hand and wrist.
Preparing for Carpal Tunnel Surgery
Carpal tunnel surgery is usually performed on an outpatient basis, meaning that you go home the day of your surgery. For your particular situation, you will be given specific instructions as to where and when to arrive at the medical facility, how to prepare for your surgery, and what to expect the day of and in the days following your surgery.
You will be asked not to eat or drink anything for at least eight hours before the surgery. Additionally, dietary restrictions may be made by your doctor. Due to medications often used for this procedure, you will not be able to drive for at least 24 hours afterward. Be sure to arrange for someone to drive you home.
Types of Carpal Tunnel Surgery
There are two different techniques used in carpal tunnel surgery: open release and endoscopic. Although each procedure is performed differently, they share the same results and complications.
Open Release
Endoscopic
Endoscopic carpal tunnel release may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about ½" each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. One-portal endoscopic surgery for carpal tunnel syndrome is also available.
Risks With Carpal Tunnel Surgery
As with all medical procedures, there are some possible risks involved in carpal tunnel surgery. These risks may involve:
- Nerve damage
- Infections
- Allergic reactions
- Complications in people who have diabetes.
Nerve Damage
The median nerve typically runs just underneath the transverse carpel ligament. After it passes through this ligament, it tends to branch off into many smaller nerves. Each of these branches allows for a certain function to occur.
Your doctor is well aware of these variations in nerve branch locations, and the techniques used during carpal tunnel surgery maximize the protection of the median nerve and its branches. However, because of these variations, in rare instances, it is possible to cut this nerve or its branches during the surgery. This can result in loss of feeling or strength in the palm, thumb, or fingers.
Infections
Despite the current sterile techniques used for all surgeries, infections are occasionally seen following
carpal tunnel release. The seriousness and subsequent treatment options will vary depending on the location. Infections can range from very minor ones that are treated with only antibiotics to very major infections requiring a repeat surgery. Furthermore, an infection after this surgery may decrease the chance of successful results through the development of scar tissue and possible stiffness.
Allergic Reactions
Most medicines are safe, but there is always the risk of having an adverse or allergic reaction. This is true for all types of medicine, including anesthesia. Some examples of minor allergic reactions are itchy eyes, runny nose, or skin rashes. In some cases, people may have a serious reaction called "anaphylaxis," which can be fatal.
There is no way for your doctor to know if you will be allergic to medicines that you have never tried. However, your healthcare team will try to find out as much information as they can to help prevent an allergic reaction. They will ask questions about medicines you are taking, your health in the past, and whether you have any existing
allergies. Please be sure to tell your healthcare providers about all of your allergies. This information will help your doctor and other healthcare providers choose the medicines that are best for you.
Complications in People Who Have Diabetes
If you have
diabetes, your risks for complications are higher. However, difficulty in healing is the main concern. For this reason, it is important to keep all scheduled follow-up appointments and return soon if any symptoms develop. Your doctor will treat any early suspected infections more aggressively with the knowledge that you are diabetic.
After
carpal tunnel surgery, these symptoms may indicate a problem. For example, an infection at the procedure site can make blood sugar control difficult and may require IV antibiotics to treat the infection. To help identify what is causing the symptoms, you may be asked to have more frequent blood sugar checks. It is important to report any changes to your doctor as soon as possible so that the appropriate treatment can be started if necessary.
Options Other Than Carpal Tunnel Surgery
Several alternative treatments exist for treating
carpal tunnel syndrome. Your doctor will usually start with the most conservative (or most cautious and safe) treatment. If your symptoms are not relieved with conservative treatment, surgery is usually recommended.
- Activity changes
- Anti-inflammatory medication
- Wearing a splint for a period of time
- Steroid shots given directly to the area surrounding the nerve.
Conservative treatment is usually tried for 8-12 weeks. However, if there is significant loss of muscle to the thumb or significant median nerve damage, surgery might be suggested sooner.
Summary of Carpal Tunnel Surgery
Carpal tunnel syndrome is the result of increased pressure on the median nerve inside the wrist. It has multiple causes and can often be treated by conservative treatment methods. When conservative treatment is unsuccessful, surgical release of the transverse carpal ligament is often recommended.
Carpal tunnel release is a proven surgical procedure with predictable results and relatively low risk. A majority of patients gain significant (if not total) improvement in their symptoms as a result of this procedure.
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