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. Healthcare providers used to think that carpal tunnel syndrome was caused only by an overuse injury or a repetitive motion done by the wrist or hand, often at work. It's now thought that those can be partly responsible.

There are other factors also involved. They are all related to increased pressure on the median nerve as it passes through the wrist. Some people have a small carpal tunnel because the condition runs in their family (congenital predisposition). Carpal tunnel syndrome can also be caused by injury. This includes 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 (or inside) of the wrist. Swelling of the tissues within the tunnel can press on the median nerve when this part of the body is injured or tight. This causes numbness and tingling of the hand, pain, and loss of function if not treated. Symptoms usually start slowly. They may get worse over time. They tend to be worse on the thumb side of the hand. It's not uncommon for a person to have carpal tunnel syndrome in both hands.

A surgeon cuts through the ligament that is pressing down on the carpal tunnel during a carpal tunnel release. This makes more room for the median nerve and tendons passing through the tunnel. It usually improves pain and function.

Why might I need carpal tunnel release surgery?

A diagnosis of carpal tunnel syndrome is about the only reason to have a carpal tunnel surgery. And even then, your healthcare provider will likely want you to try nonsurgical treatments first. These may include:

• Over-the-counter pain medicines

• Physical therapy

• Changes to the equipment you use at work

• Wrist splints

• Shots of steroids in the wrist to help ease swelling and pain

The reasons that a healthcare provider would recommend a carpal tunnel release surgery may include:

• The nonsurgical interventions for carpal tunnel syndrome don’t relieve the pain.

• The healthcare provider performs an electromyography and nerve conduction test of the median nerve. They then determine that you have carpal tunnel syndrome.

• The muscles of the hands or wrists are weak and actually getting smaller. This is because of the severe pinching of the median nerve.

• The symptoms of carpal tunnel syndrome have lasted a prolonged period of time with no relief.

What are the risks of carpal tunnel release surgery?

As with most surgeries, carpal tunnel release is not without its risks. Your wrist will be made numb and you may be given medicine to make you sleepy and not feel pain (called local anesthesia) for the procedure. In some cases, general anesthesia is used. This is when medicines are used to put you into a deep sleep during surgery. Anesthesia poses risks for some people. Other potential risks of a carpal tunnel release surgery include:

• Bleeding

• Infection

• Injury to the median nerve or nerves that branch out from it

• Injuries to nearby blood vessels

• A sensitive scar

• The need for more surgery

The recovery from carpal tunnel surgery takes time. It can be anywhere from several weeks to several months. Recovery may take even longer if the nerve has been compressed for a long period of time. Recovery involves splinting your wrist and getting physical therapy to strengthen and heal the wrist and hand.

There may be other risks, depending on your specific medical condition. Talk about any concerns with your healthcare provider before the procedure.

How do I get ready for carpal tunnel release surgery?

• Tell your healthcare provider about all medicines you are currently taking. These include over-the-counter medicines, vitamins, herbs, and supplements. You will probably need to stop taking any medicines that make it harder for the blood to clot, such as ibuprofen, aspirin, or naproxen.

• If you’re a smoker, try to quit before the surgery. Smoking can delay healing.

• You may need to get blood tests or an electrocardiogram before surgery.

• Follow any directions you are given for not eating or drinking before surgery.

Your healthcare provider may request other specific preparations based on your medical condition.

What happens during carpal tunnel release surgery?

Carpal tunnel release is usually an outpatient procedure. That means that you can go home the same day as the surgery if all goes well. There are three types of carpal tunnel release surgery. The traditional method is the open release. This is where the surgeon cuts open the wrist to do the surgery.

PMuscsk_20140312_v0_002

The other methods are endoscopic carpal tunnel release or ultrasound guided carpal tunnel release. During endoscopic surgery, a thin, flexible tube that contains a camera is put into the wrist through a tiny cut (incision). The camera guides the healthcare provider as the surgery is done with thin tools put into the wrist through another small cut. The surgeon uses ultrasound machine to position a small probe in the carpal tunnel next to the median nerve with ultrasound-guided surgery.

PMuscsk_20140312_v0_003

In either case, here are the general steps in a carpal tunnel release surgery:

1. You will usually be asked to remove your clothing, or at least your shirt, and put on a hospital gown.

2. You will be asked to sign a surgical consent form to give your surgeon permission to do the procedure. Read the consent carefully and ask any questions you may have.

3. Typically, local anesthetic is used for this procedure to numb the hand and wrist.

4. In an open release surgery, the surgeon makes about a 2-inch cut on the wrist. They use common surgical tools to cut the carpal ligament and make the carpal tunnel larger.

5. In an endoscopic or ultrasound-guided carpal tunnel release, the surgeon makes 1 half-inch cut on the wrist. Then they put a camera attached to a narrow tube into the cut. Or a small probe without a camera. The camera guides the surgeon as they insert the instruments and cut the carpal ligament through the other incision. When there is no camera, the ultrasound device guides the surgeon on the right placement of the probe before cutting the carpal ligament.

6. The surgeon will stitch up the cut or cuts.

7. Your hand and wrist will be placed in a splint or bandaged heavily to keep you from moving your wrist.

Once the surgery is done, you’ll be watched for a short time. Then you are allowed to go home. Only in rare cases, or if there are complications, you will need to stay overnight.

What happens after carpal tunnel release surgery?

Your wrist will likely be in a heavy bandage or a splint for 1 to 2 weeks. Healthcare providers 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 above your heart while sleeping at night. This will help to decrease swelling.

You'll likely begin a physical therapy program once the splint is removed. 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 healthcare provider will talk to you about activity restrictions you should follow after surgery.

Let your healthcare provider 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 healthcare provider about what you should expect and what problems mean you need to see your healthcare provider right away.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure