Carpal Tunnel Release Surgery

Overview

Carpal tunnel syndrome is a common condition affecting the hands, wrists, arms and neck region of many patients. Swelling, injury or pressure within the tunnel impacts the median nerve, the nerve in the forearm, resulting in pain or discomfort. Surgery to correct carpal tunnel syndrome focuses on reducing pressure on the median nerve.

Diagnosing carpal tunnel syndrome

The most important goal of the diagnostic and imaging exams is to diagnose the carpal tunnel syndrome. There are conditions, such as pregnancy, arthritis, thyroid disease or diabetes that can cause similar symptoms.

As part of the diagnostic process, your health-care provider will likely perform a full range of diagnostic tests for carpal tunnel syndrome and the appropriate imaging studies. The health-care provider will also do a full physical exam, looking closely at the wrist area for pain or swelling.

The main purpose of surgery for carpal tunnel syndrome is to release the band of tissue, known as the transverse carpal ligament, surrounding the median nerve. The transverse carpal ligament acts like a rubber band holding the tendons of the arm and hand and the median nerve.  If there is swelling within the carpal tunnel, the transverse carpal tunnel ligament tightens, putting pressure on the median nerve and causing pain. The surgery is called release surgery because by cutting the transverse carpal tunnel ligament, it can help release pressure on the median nerve.

Surgery may be an option for patients whose pain or discomfort from carpal tunnel syndrome has lasted several months, even up to a year. Surgery will be considered for those patients in whom conservative, or nonsurgical, therapies have not been effective or are unable to provide long-term relief. Nonsurgical options for carpal tunnel syndrome may include:
  • A splint or wrist brace
  • Activity modification
  • Medical management, such as nonsteroidal anti-inflammatory drugs
  • Physical therapy
  • Steroid injections
While conservative methods may reduce the symptoms associated with carpal tunnel syndrome, surgery can help treat the underlying cause of the condition: pressure on the median nerve.

Procedural Details

The goal of surgery is to cut the transverse carpal tunnel ligament in order to open up the space inside the carpal tunnel area.
There are two main types of surgery available for carpal tunnel syndrome:

Open carpal tunnel release
In surgical terms, open refers to traditional surgery, and involves making a one- to two-inch incision in the wrist. The incision, or opening, allows the surgeon to directly see and then cut the transverse carpal ligament. The release is immediate and helps reduce pressure on the median nerve. The incision is then closed with stitches.

Endoscopic carpal tunnel release
The word endoscopic refers to the use of specialized instruments and cameras to indirectly approach and then sever the transverse carpal tunnel ligament. The surgeon may make one or two small incisions in the wrist near the transverse carpal ligament.  A small tube is temporarily inserted into the operation area for housing the other instruments during the surgery. The instruments are used to see and then to cut the transverse carpal ligament. After the ligament has been released, the tube and other instruments are removed, and the incision site is closed with stitches.

Endoscopic surgery is also called laparoscopic or keyhole surgery. Because the incision is smaller for the endoscopic technique compared to the open technique, the endoscopic surgery may have faster recovery times. Open carpal tunnel release may be recommended if the surgeon is not able to see the entire transverse carpal ligament using the endoscopic equipment or if it is a repeat procedure.

Both procedures are typically done with local anesthesia by numbing the wrist area on an outpatient basis, not requiring a hospital stay. Both types of surgery allow for recovery within a few weeks with minimal scarring. Your doctor can help you decide what surgical option is best for you.

Recovery

After the surgery, the entire wrist and forearm will remain bandaged for a few days. Driving is not recommended immediately following surgery even though you may still have limited use of your thumb and fingers. Most patients need some assistance with daily activities but are able to still do basic tasks, such as getting dressed or eating.

If a small tube or drain is placed into the surgery site to help remove excess fluids, you will need to return to the health-care provider’s office to have the drain removed. Your wrist will then be placed into a plastic splint to prevent motion near the surgical site. You may have to wear a splint for at least a week or two, or for as long as your health-care provider advises. At this time, you may also be prescribed some exercises to help with the recovery process.

Depending upon the speed of your recovery, you may be able to return to normal activities in six to eight weeks. Your health-care provider may prescribe physical therapy or other specialized exercises. Some patients experience some tingling or numbness for up to several months after the surgery, but those reduce with time.

Medications

Your doctor may also prescribe pain or anti-inflammatory medication. You may also be able to use over-the-counter medications, such as acetaminophen, ibuprofen or naproxen.

Considerations

If you have discomfort in both hands due to carpal tunnel syndrome, you may choose to have both wrists operated on at one time. While this means going through the recovery process only once, you will have limited use of both of your hands for several weeks. Assistance is recommended for daily tasks, including household chores. Talk to your doctor to see if a dual surgical option is right for you.

Effectiveness

Carpal tunnel release surgery is an effective surgery. After recovery, patients experience minimal scarring and rarely need the surgery repeated. After recovery from surgery, you should try to reduce the activities that caused the carpal tunnel syndrome initially, such as repetitive motions or overuse of the hand or wrist.

Risks of having treatment

  • As with any surgical procedure, the risks include the possibility for infection or nerve damage.
  • Patients may require assistance in completing daily chores, including self-care, for some time after the surgery. There may also be some lingering weakness or numbness, which should get better with time.
  • Be sure to address any questions or concerns you have with your health-care provider.

Risks of not having this treatment

If left untreated, severe cases of carpal tunnel syndrome can lead to permanent numbness or weakness. Patients may lose strength or grip in their hands or arms, causing them to drop objects or lose sensation. Treatment for carpal tunnel syndrome can help restore normal function.

Urgency

Carpal tunnel syndrome may take months or years to develop. Untreated carpal tunnel syndrome can lead to long-term nerve and muscle injury, weakness or other disability.