Carpal Tunnel Surgery Treatment

What is Carpal Tunnel Surgery?

Carpal tunnel surgery, also called carpal tunnel release and carpal tunnel decompression surgery is a surgical procedure in which the transverse carpal ligament is divided. It is used for treating the carpal tunnel syndrome and is recommended when there is muscle weakness, constant numbness, or atrophy, and when night-splinting is no longer able to control the intermittent symptoms of pain in the carpal tunnel. All in all, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and result in surgical treatment.

Treatment                                              

Non-Surgical Treatment

If diagnosed and treated early, the symptoms of carpal tunnel syndrome can be usually relieved without any surgery. If the diagnosis is uncertain or if the symptoms are mild, the doctor will suggest nonsurgical treatment first.

Nonsurgical treatments may include:

• Bracing or splinting: By wearing a brace or splint at night will protect the wrist from bending while the patient is asleep. The wrist must be kept in a straight or neutral position; this will reduce the pressure on the nerve in the carpal tunnel. It may also help in wearing a splint during the day when performing activities that may aggravate symptoms.
• Nonsteroidal anti-inflammatory drugs: Medications such as ibuprofen and naproxen can useful in relieving pain and inflammation.
• Activity changes: Symptoms can usually occur when the hand and wrist are in the same position for too long, particularly when the wrist is flexed or extended. If the patient’s job or recreational activities aggravate the symptoms, modify or change in activities can help in slowing or stopping the progression of the disease. In some cases, this may involve changing in the work site or in the work station.
• Nerve gliding exercises: Some patients may be benefited from the exercises. The exercise helps the median nerve move more freely within the confines of the carpal tunnel. Specific exercises may be recommended by the doctor or therapist to the patient.
• Steroid injections: Corticosteroid (cortisone) is a powerful anti-inflammatory agent that can be introduced into the carpal tunnel. Although these injections help in relieving these painful symptoms or help to calm a flare-up of symptoms, their effect is only temporary. A cortisone injection may also be used by the doctor to help diagnose the patient’s carpal tunnel syndrome.

Surgical Treatment

If nonsurgical treatment does not relieve the symptoms after a period of time, the doctor may recommend surgery. The decision of whether to have surgery is based on the severity of the symptoms, how much pain and numbness the patients are having in their hand. In long-standing cases with constant numbness and wasting of the thumb muscles, surgery may be suggested to prevent irreversible damage.

Surgical Procedure

The surgical procedure done for carpal tunnel syndrome is called a carpal tunnel release. There are two different surgical techniques for performing this, but the goal of both is to relieve the pressure on the median nerve by cutting the ligament that forms the roof of the tunnel. This increases the size of the tunnel and thus decreasing the pressure on the median nerve. In most of the cases, carpal tunnel surgery is performed on an outpatient basis. The surgery can be performed under the general anesthesia, which puts the patients to sleep, or under local anesthesia, which only numbs the patient’s hand and arm. In some of the cases, the patients will be given a light sedative through an intravenous (IV) line inserted into a vein in their arm.

Open carpal tunnel release: In open surgery, the doctor makes a small cut in the palm of the patient’s hand and views the inside of the hand and wrist through this cut made on the palm. During the procedure, the doctor will divide the transverse carpal ligament. This results in the increases in the size of the tunnel and thus decreasing the pressure on the median nerve. After the surgery, the ligament may gradually grow back together with time, but there will be more space in the carpal tunnel and the pressure on the median nerve will be relieved.

Endoscopic carpal tunnel release: In endoscopic surgery, the doctor makes one or two smaller skin incisions, called the portals, and with the help of a miniature camera (an endoscope) the doctors can see inside the hand and wrist. A special knife is used for dividing the transverse carpal ligament, which is similar to the open carpal tunnel release procedure.

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Why carpal tunnel Surgery is required?

Carpal tunnel surgery is considered when:

• Symptoms are still present even after a long period of nonsurgical treatment. Surgery is not considered until after several weeks to months of nonsurgical treatment.
• Severe symptoms such as coordination in the fingers or hand, or persistent loss of feeling or no strength in the thumb restrict the day to day activities.
• There is damage to the median nerve or there is a risk of nerve damage.
• Tumors or other growths are needed to be removed.

What Complications can happen?

With any surgery, there is a possibility of complications, the doctor every possible step to minimize the risks. The most common complications of carpal tunnel surgery may include:

• Bleeding
• Infection
• Nerve aggravation or injury

How Soon will I recover?

The patients may get relief from symptoms the same day as their surgery, but complete healing takes longer time. The patients may experience pain, swelling, and stiffness after the operation. The doctor will prescribe the medicines that might help the patients. The patients may have some soreness for anywhere from a few weeks to a few months after surgery. The bandages will stay on for 1-2 weeks. The doctor may provide exercises to do during this time for moving the fingers and keep them from getting too stiff. The patients can use their hand lightly for the first 2 weeks, but it will help to avoid strain.

Slowly, the patients can get back to more normal activities, such as:

• Driving (only after a couple of days of the surgery)
• Writing (after a week, but after 4-6 weeks it will feel easier.)
• Pulling, gripping, and pinching

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