Carpal tunnel release is a surgical procedure to treat carpal tunnel syndrome. Carpal tunnel syndrome is a condition caused by trapped nerve (median nerve) in your wrist.
This can result in weakness, pain, tingling and numbness in your hand and wrist. Pain may occasionally radiate up your arm.
This procedure involves cutting open the ligament (transverse carpal ligament) which covers the narrow carpal tunnel. The main aim is to relieve the pressure.
Who is this operation for?
Indications for surgery:
- Symptoms are not relieved by non-surgical therapies including splint, anti-inflammatory medications and steroid injections
- Weakness and shrinkage of muscles controlling the thumb
- Constant numbness of the hand
- Damage to the median nerve (shown by nerve test results and loss of hand or finger function)
- Sudden development of carpal tunnel syndrome from trauma or infection
Complications
The risks and complications of a carpal tunnel release:
General complications:
- Bleeding
- Infection
- Pain
Specific complications:
- Pillar pain (25%)
- Recurrence (7-20%)
- Scar may be prominent and thicken (hypertrophic scar)
- Tendon adhesion
- Bleeding into wound (Wound hematoma)
- Finger stiffness
- Neurovascular injury (median nerve, superficial palmar arterial arch)
- Incomplete release of the transverse carpal ligament (TCL)
- Failure to recognize concomitant injuries
Before the operation
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
•Doctor
•Nurse
•Anaesthetist (if necessary)
Tests
Tests that may be ordered for you include:
– Blood tests
– Xray wrist
– Urine Test
– ECG
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Medications
Our doctors will advise you which medications you should stop or can continue taking before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
About the Operation
Carpal tunnel release may be performed in an open or endoscopic (see Arthroscopy) manner. This surgery can be done under general anaesthesia, regional or local anaesthesia. A regional anaesthetic blocks the nerves going to only a portion of the body. In most cases, carpal tunnel release is done on an outpatient basis under local anaesthesia.
The site of surgery is marked before the surgical procedure. The anaesthetist will put in a drip for administration of drugs and fluids. Local anaesthetic is then injected. Once you have anaesthesia, your surgeon will clean the skin of your palm with a germ-killing solution to make sure it is free of germs.
A small incision is made in the palm of your hand, the length varies but usually it is <4cm. The incision makes the palmar fascia visible. This is a sheet of connective tissue in the palm. The doctor makes an incision via this layer and exposes the carpal ligament. Carpal ligament is then cut using a scissors or scalpel. Care is taken to avoid injury to the median nerve. Pressure is relieved by releasing this ligament.
After the ligament is cut, the skin is closed with stitches. The gap where the ligament was cut is left alone and eventually fills in with the scar tissue. Your hand will be wrapped in a bulky dressing.
After the Operation
You may be required to wear a wrist brace for up to 3 weeks. Elevation of the wrist is essential to prevent excessive pain and swelling from occurring. You may be instructed to put an ice pack on your wrist several times a day to reduce swelling.
At various times during the day, move your fingers and thumb 5 to 10 times. Keep the dressing on your hand until you return to the surgeon. Avoid getting the stitches wet. Your stitches will be removed 10 to 14 days after surgery.Movements such as heavy gripping and pinching should be avoided for up to 6 weeks. This is to prevent the tendons from pushing out against the healing carpal ligament.
Recovery and Rehabilitation
Most patients’ symptoms will improve after surgery, but recovery may be gradual. Minor soreness in the palm is common for several months after surgery. Weakness of pinch and grip may persist for up to 6 months. In long-standing carpal tunnel syndrome, recovery might not be complete.
Your doctor may refer you to work with a hand therapist. Patients are treated 2 -3 times each week for 4-6 weeks. Initially, your therapist will attempt to reduce swelling and pain. This is done by hot/cold packs and massage strokes. This is followed by active hand and wrist exercises to encourage range of motion. Another aim is to prevent scar tissue formation. Therapists use scar massage to reduce scar tissue formation. As you progress, the therapist will focus on hand exercises that strengthen and stabilise the muscles and joints of the hand. Finally, your therapist will teach you ways to do your daily tasks without putting too much stress on your hand and wrist.
F.A.Q.s | Frequently Asked Questions
Prognosis
Most people are helped by this surgery. The length of recovery will depend on how badly damaged your median nerve is and how long you had symptoms before surgery. If you had symptoms for a long time, you may not be completely free of symptoms after your recovery.
Does open surgery or keyhole surgery provide better results for relieving carpal tunnel syndrome?
Both are as good as one another at reducing symptoms associated with carpal tunnel syndrome. Your doctor will discuss the surgical procedures that best meets your need.
Can I have carpal tunnel surgery if I’m pregnant?
Although this surgery is safe to perform during surgery, it’s best to delay treatment until after you have given birth. This is because carpal tunnel symptoms related to pregnancy will often improve spontaneously and go away after you have had your baby.