Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common condition that causes pain, numbness, tingling, and weakness in the hand and wrist. Carpal tunnel syndrome occurs when the median nerve is compressed. The median nerve travels through the carpal tunnel, a narrow passageway located on the palm side of the hand. The nerve sits between bone and ligaments and can become compressed by these structures. This can lead to symptoms that range from uncomfortable to debilitating.
Individuals suffering from mild symptoms caused by carpal tunnel syndrome may experience relief by wearing a wrist splint or using anti-inflammatory medications. However, sometimes, the pain, numbness, and tingling do not improve on their own. If left untreated, carpal tunnel syndrome can cause severe issues with hand movement. To determine if you need carpal tunnel surgery, your surgeon may perform a nerve conduction study to analyze how quickly nerves in your hand communicate to appendages.
Surgical Candidates
If you have failed conservative treatment options for carpal tunnel syndrome, your surgeon may recommend a carpal tunnel release surgery for one of the following reasons:
The nonsurgical interventions for carpal tunnel syndrome failed to relieve the pain.
The surgeon performs an electromyography test of the median nerve and determines that you have carpal tunnel syndrome.
The muscles of the hands or wrists are weak and actually getting smaller because of the severe pinching of the median nerve.
The symptoms of carpal tunnel syndrome have lasted six months or longer without relief.
Types of Carpal Tunnel Surgeries
Carpal tunnel release is usually an outpatient procedure, which means that you can go home the same day as the surgery if all goes well. There are two types of carpal tunnel release surgery.
open carpal tunnel release surgery
The traditional method is the open release, in which the surgeon cuts open the wrist to do the surgery. During open carpal tunnel release surgery, the transverse carpal ligament is cut, which releases pressure on the median nerve and relieves the symptoms of carpal tunnel syndrome.
An incision is made at the base of the palm of the hand. This allows the doctor to see the transverse carpal 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 up with scar tissue.
If you have open carpal tunnel release surgery, you typically do not need to stay in the hospital. It is usually done under local anesthetic, and you can go home on the same day.
recovery - Open carpal tunnel release surgery
After surgery, the hand is wrapped. The stitches are removed 10 to 14 days after surgery. The pain and numbness may go away right after surgery or may take several months to subside. Try to avoid heavy use of your hand for up to 3 months.
When you return to work depends on whether the dominant hand (the hand you use most) was involved, what your work activities are, and how much effort you put into rehabilitative physical therapy.
If you have surgery on your non dominant hand and do not do repetitive, high-risk activities at work, you may return to work within 1 to 2 days, although 7 to 14 days is most common.
If you have surgery on your dominant hand and do repetitive activities at work, you may require 6 to 12 weeks for a full recovery before you can return to previous work duties. Physical therapy may speed your recovery.
Endoscopic carpal tunnel release surgery
Endoscopic surgery uses a thin tube with a camera attached (endoscope). The endoscope is guided through a small incision in the wrist (single-portal technique) or at the wrist and palm (two-portal technique). The endoscope lets the surgeon see structures in the wrist, such as the transverse carpal ligament, without opening the entire area with a large incision.
The cutting tools used in endoscopic surgery are very small. They are inserted through the small incisions in the wrist or wrist and palm. In the single-portal technique, one small tube contains both the camera and a cutting tool.
During endoscopic carpal tunnel release surgery, the transverse carpal ligament is cut. This releases pressure on the median nerve and relieves carpal tunnel syndrome symptoms.
The small incisions in the palm are closed with stitches. Over time, the gap where the ligament was cut will fill with scar tissue.
Recovery - endoscopic carpal tunnel release surgery
Your wrist will be in a heavy bandage or splint for one to two weeks following surgery. Your surgeon will schedule a post-operative appointment to remove the bandage or splint. During this time, you will be encouraged to move your fingers to help prevent stiffness. You may experience pain in your hand and wrist after surgery. Your surgeon may also have you keep the affected hand elevated while sleeping at night to help decrease swelling.
Once the splint is removed, you will begin your post-operative physical therapy program. Your physical therapist will teach you motion exercises to improve the movement of your wrist and hand. These exercises will speed healing and strengthen the area. You may still need to sometimes use a splint or brace for a month or so after surgery.
The recovery period can take anywhere from a few days to a few months. In the meantime, you may need to adjust job duties or even take time off from work while you heal. Your surgeon will talk to you about activity restrictions you should follow after surgery.