Why Do I Need Carpal Tunnel Release Surgery
You may be offered carpal tunnel release surgery if you have particularly severe symptoms, or youve tried other treatments, such as wrist splints and steroid injections, and youre still having problems.
You can access a range of treatments on a pay as you go basis, including physiotherapy. Find out more about physiotherapy >
What Is Carpal Tunnel Surgery
Carpal tunnel surgery is a simple procedure to release the transverse carpal ligament at the carpal tunnel, releasing the pressure on the median nerve.
Carpal tunnel surgery is one of the most common and efficient hand procedures on offer. The procedure itself takes just 10 minutes, and taking into account preparations such as the delivery of local anaesthetic, youll be in and out of the operating theatre within half an hour. Preparation is minimal the only thing you might need to do is to stop taking blood thinning medication prior to the operation.
There are two main types of carpal tunnel surgery:
- Open carpal tunnel release this involves making a small cut in your palm. It is the most common form of surgery.
- Endoscopic carpal tunnel release this involves a slightly smaller incision but may carry greater risk of complications and longer to perform.
Whichever type of surgery is performed, the procedure should give you immediate pain relief.
What Is Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is sometimes associated with hormonal changes such as pregnancy or an underactive thyroid. In most cases no specific cause is known, but previous trauma or cysts may cause swelling of the tunnel which presses on the nerve.
Treatment for mild symptoms may be to use a splint or have a cortisone injection. If these do not work or the symptoms come back, surgery can be performed. This involves dividing the carpal ligament on the upper surface of the tunnel, to take the pressure off the nerve.
Carpal Tunnel Syndrome is the name given to a group of symptoms which are caused by pressure on the median nerve. This nerve travels down the arm and supplies sensation to the thumb, the index, middle and half the ring finger. It also controls some movements of the thumb. At the wrist it travels through the carpal tunnel, which it shares with the tendons which bend the fingers. Typical symptoms are numbness, pins and needles and pain in the hand, which is often worse at night or with repetitive movements.
The position of the median nerve in the wristThe part of the hand usually affected in CTS
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About Carpal Tunnel Release Surgery
Carpal tunnel release surgery also called carpal tunnel decompression involves cutting your carpal ligament. This ligament is connected to bones in your wrist to form the carpal tunnel. Several tendons and your median nerve, which controls movement and feeling in your hand, run through this tunnel to your fingers. In carpal tunnel syndrome, your median nerve becomes compressed, typically causing tingling, numbness and pain in your hand. Dividing the carpal ligament releases the pressure in your carpal tunnel and can ease your symptoms.
What Happens After Carpal Tunnel Surgery
Your wrist will likely be in a heavy bandage or a splint for 1 to 2 weeks. Doctors usually schedule another appointment to remove the bandage or splint. During this time, you may be encouraged to move your fingers to help prevent stiffness.
You’ll probably have pain in your hand and wrist after surgery. It’s usually controlled with pain medicines taken by mouth. The 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 likely begin a physical therapy program. The 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 doctor will talk to you about activity restrictions you should follow after surgery.
Let your doctor know about any of the following:
- Fever
- Redness, swelling, bleeding, or other drainage from the incision
- Increased pain around the incision
These problems may need to be treated. Talk to your doctor about what you should expect and what problems mean you need to see your doctor right away.
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What To Expect After The Operation
Scar
Dressings
Rehabilitation
Not everyone needs to see a physiotherapist after surgery unless there is a problem with scar pain or stiffness. Some general rules that are useful for everyone are:
- Hand elevation is important to prevent swelling and stiffness of the fingers.
- Remember not to walk with your hand dangling, or to sit with your hand held in your lap.
- It is fine, however, to lower your hand for light use and you should get back to normal light activities as soon as possible as guided by common sense.
- It is safe to use the fingers for day-today activities such as eating, dressing, brushing your hair. These activities all help to prevent stiffness and swelling.
Symptoms
The pain and tingling you experienced at night before the operation should settle immediately. If you have established numbness, dryness, lost dexterity or wasting of the muscle at the base of the thumb, then recovery of these problems is uncertain, especially as you get older. Ideally, surgery should be performed before these problems develop.
Stitches
Your stitches will be removed at about 10 to 14 days after the operation.
Recovery
You will find that your grip is weaker than before the operation and slightly uncomfortable. This can be a bit frustrating but you should be back to full power by 6 to 12 weeks as healing occurs. Exercises such as squeezing balls will not speed up the process, and if overdone this can actually delay your recovery.
Painkillers
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Complications Of Carpal Tunnel Release Surgery
Complications are problems that may happen during or after your procedure. All surgical procedures carry a risk of certain complications. The most common complications associated with carpal tunnel release surgery include the following. Your surgeon can explain how the risk of these apply to you.
- Infection of your wound. This can be treated with antibiotics.
- Bleeding, which may form a collection of blood under your skin .
- A tender and sensitive scar. This is a minor issue for most people that gradually improves. However, some people find that the problem continues for months or years, and interferes with day-to-day activities.
- Damage to nerves in your wrist. This may cause temporary pain and numbness in your hand. In rare cases, loss of feeling and strength in your hand may be permanent.
Other problems associated with carpal tunnel release surgery, such as ongoing problems with pain, are very rare. Do tell your surgeon if youre experiencing any problems. If necessary, they can refer you for more treatment, including physiotherapy.
Most people find their symptoms of carpal tunnel syndrome disappear after surgery, but theres a chance that your symptoms may continue or come back. This may be because your carpal ligament wasnt cut deeply enough to release the pressure. If this happens, you may need to have more surgery.
How To Take Care Of Your Hand After Carpal Tunnel Surgery
Most patients wear a splint or heavy bandage for up to two weeks after surgery. You may need to have a follow-up appointment to remove the dressing.
If your hand is in a splint following the surgery, you should be sure to move your fingers periodically to combat stiffness. To reduce the swelling in your hand after surgery, you may have to keep your hand elevated while you sleep.
Following the removal of the splint, its time to begin physical therapy. Youll engage in motion exercises to strengthen your wrist and hand, though you may still have to occasionally use the splint when your hand hurts.
Your surgeon may restrict your activities for some time after the surgery. For instance, if your work involves typing, you may have to stay home for a while or modify your work. How you progress after surgery depends on a number of factors, including:
- Age.
- Health and the presence of preexisting conditions, such as arthritis.
- How well you listen to the surgeons instructions.
You will see immediate progress soon after the surgery, but it could be three months to a year before you realize all the benefits of the procedure. Grip strength returns about three months afterward, and you can begin participating in sports about two months later as long as you dont experience a lot of pain.
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Return To Work After Surgery
For patients in employment a frequent question is how long will I be off work? Although the topic has been quite extensively documented it turns out to be a difficult question to answer. Much of the existing literature on surgical treatment for CTS comparing different variations of surgery, for example traditional open surgery vs one of the endoscopic methods, uses the time to return to work after surgery as one measure of outcome, and it has been fairly convincingly shown that return to work times are a couple of days shorter for endoscopic than for open surgery. What this finding tends to conceal is the fact that other factors are much more important than the type of surgery in determining the length of time off work. It should be obvious, when you think about it, that the type of work involved is going to be a major determinant of time off, and indeed this proves to be so.
A large study in France , reported a median time to return to work after carpal tunnel surgery of 60 days and found that type of occupation was the strongest determinant of how long the patient would be off, with manual ‘blue-collar’ workers requiring most time off. One american study found that 23% of patients still had not returned to work 6 months after surgery. In contrast in Denmark the mean sick leave after surgery was 20 days and only 3% of patients were still unable to work 3 months after surgery . In Norway the median time off was 7 weeks with 10% unable to return to work at all .
What To Expect After Carpal Tunnel Surgery
Has your doctor told you what to expect after carpal tunnel surgery? If youre still wondering, you probably didn’t get all the answers you wanted.
If you’re thinking about having this hand surgery you mustfeel comfortablewith your decision. No doubt, you need to dosomethingto get rid of the terriblecarpal tunnel symptoms.So surgery seems like the way to go.
To get to this point about deciding on surgery, most patients have been living withsevere carpal tunnel syndromefor at least 6 months. So who could blame you for wanting to end the punishing pain or crushing numbness in your fingers or hand?
In fact, many patients tell me,”Doc, I feel like cutting my hand off!”
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Patients come to the surgery decision because these symptoms are never-ending. They rob your sleep and just make life miserable.
Hopefully your doctor tried allnon-surgical treatmentsfirst because many arequite effective.But if you’ve tried everything with no results, carpal tunnel surgery may be your only alternative.
Here’s what happens during the operation and what to expect after the surgery is over.
After you’ve considered everything here, weigh all the advantages and disadvantages of surgery withyour doctor.After that discussionanddoing your homework, you might find that surgery isn’t the magic bullet you’re hoping for.
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Guide To Aftercare For Carpal Tunnel Surgery
It’s at home, after the operation, that your aftercare for carpal tunnel surgery actually begins. It’s also the beginning of a long haul. But with the right preparation it will be over before you know it.
Getting comfortable with knowing what to expect aftercarpal tunnel release surgeryis the smart thing to do right now. Easing the anxiety about the unknown makes life better all around. So understanding whatto expect andwhenis a great start.
Depending on how fast you heal and how well you manage the pain, aftercare is usually relatively simple. YES, there will be post-surgical pain to deal with. And that’s why you’ll have pain medicines on hand.
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The only other major concern to think about is the possibility ofcomplicationsduring recovery. Common complications include problems like delayed reaction to the anesthesia, bleeding, infection or nerve damage. Any of those can make the surgery aftercare more lengthy and complicated.
But lets stay positive! We’ll assume there won’t be complications and all goes well during yourcarpal tunnel surgery recovery.
Carpal Tunnel Syndrome: When Is Surgery Considered Or Needed
Most people with carpal tunnel syndrome only consider having surgery if other treatments don’t provide enough relief. Surgery can help relieve symptoms or make them go away for good, but it is not without risks.
In carpal tunnel syndrome the median nerve, which runs through the carpal tunnel in your wrist, is squashed. This can cause pain, tingling and numbness, and affect certain hand movements. Surgical treatment involves cutting a fibrous band on the inside of the wrist, known as the flexor retinaculum. The aim is to reduce pressure on the median nerve. This is one of the most commonly performed surgical procedures in Germany.
Although surgery sometimes makes the symptoms go away for good, it’s not always necessary. Other treatments are usually preferred, especially if the condition is still in an early stage. Urgent surgery is usually only needed for treating a very uncommon condition called acute carpal tunnel syndrome.
There are two possible surgical procedures:
- Open carpal tunnel release: The surgeon makes a cut on the inside of the wrist, and then cuts right through the flexor retinaculum.
- Endoscopic carpal tunnel release: Here the surgeon has to make a cut on your palm and your wrist. They insert a very small camera through one of the cuts to monitor the procedure, and guide an instrument through the second cut to then cut right through the flexor retinaculum. Another endoscopic technique involves using just one small cut in the wrist.
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What Is Carpal Tunnel Release Surgery
Carpal tunnel release is a surgery used to treat and potentially heal the painful condition known as carpal tunnel syndrome. Doctors used to think that carpal tunnel syndrome was caused by an overuse injury or a repetitive motion performed by the wrist or hand, often at work. They now know that it’s most likely a congenital predisposition some people simply have smaller carpal tunnels than others. Carpal tunnel syndrome can also be caused by injury, such as a sprain or fracture, or repetitive use of a vibrating tool. It’s also been linked to pregnancy, diabetes, thyroid disease, and rheumatoid arthritis.
The median nerve and tendons that allow your fingers to move pass through a narrow passageway in the wrist called the carpal tunnel. The carpal tunnel is formed by the wrist bones on the bottom and the transverse carpal ligament across the top of the wrist. When this part of the body is injured or tight, swelling of the tissues within the tunnel can press on the median nerve. This causes numbness and tingling of the hand, pain, and loss of function if not treated. Symptoms usually start slowly, and may get worse over time. They tend to be worse on the thumb side of the hand.
During a carpal tunnel release, a surgeon cuts through the ligament that is pressing down on the carpal tunnel. This makes more room for the median nerve and tendons passing through the tunnel, and usually improves pain and function.
What Happens During Carpal Tunnel Surgery
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 2 types of carpal tunnel release surgery. The traditional method is the open release, in which the surgeon cuts open the wrist to do the surgery.
The other method is endoscopic carpal tunnel release, in which a thin, flexible tube that contains a camera is put into the wrist through a tiny incision . The camera guides the doctor as the surgery is done with thin tools put into the wrist through another small cut.
In either case, here is the general sequence of events in a carpal tunnel release surgery:
- You will usually be asked to remove your clothing, or at least your shirt, and put on a hospital gown.
- Typically, local anesthetic is used for this procedure to numb the hand and wrist.
- In an open release surgery, the surgeon cuts about a 2-inch incision on the wrist. Then he or she uses common surgical instruments to cut the carpal ligament and enlarge the carpal tunnel.
- In an endoscopic carpal tunnel release, the doctor makes 2, half-inch incisions. One is on the wrist, and one is on the palm. Then he or she inserts a camera attached to a narrow tube into one incision. The camera guides your doctor as he or she inserts the instruments and cuts the carpal ligament through the other incision.
- The surgeon will stitch up the incision or incisions.
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