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Carpal Tunnel Release
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Carpal Tunnel Release

En Español (Spanish Version)

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Definition

Carpal tunnel release is surgery to relieve pressure on the median nerve.

Pressure on the median nerve causes carpal tunnel syndrome . This may occur when people use their hands and wrists repeatedly in the same way. It also may occur as the result of certain illnesses, such as rheumatoid arthritis .

Parts of the Body Involved

Palm and wrist

Reasons for Procedure

The median nerve passes through the wrist, to the hand through the carpal tunnel. The carpal tunnel is made up of the bones of the wrist and a ligament called the transverse carpal ligament. Swelling due to injury or fluid changes, or hereditary narrow tunnel can cause increased pressure on the median nerve. This results in numbness and tingling in the thumb, index finger, middle finger, and part of the fourth finger. It also causes a weakening of the hand's grasp. This is known as carpal tunnel syndrome.

Surgery to treat carpal tunnel syndrome is usually recommended in the following instances:

  • Other therapies have failed, including icing, splints or braces, anti-inflammatory medications, steroid injections, physical therapy, or ultrasound
  • There is shrinkage (atrophy) and weakness of the muscles controlling the thumb
  • Studies of nerve functioning show the median nerve is not working properly

Risk Factors for Complications During the Procedure

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam (concentrating on strength and sensation in the affected hand or hands)
  • Nerve conduction studies—a measure the ability of the nerve to send impulses to the muscles of the thumb
  • Electromyogram (EMG)—a recording of the electrical currents generated in an active muscle
  • MRI scan (rarely done)—a test that uses magnetic waves to make pictures of structures inside the body

In the days leading up to your procedure:

  • Arrange for a ride to and from the procedure.
  • Arrange for help at home after the procedure.
  • The night before, eat a light meal and do not eat or drink anything after midnight.
  • You may be asked to shower the morning of your procedure, and you may be given special antibacterial soap to use.

During Procedure

General anesthesia or sedation will be administered.

Anesthesia

You and your doctor will discuss the use of general anesthesia or local anesthesia with sedation.

Description of the Procedure

Carpal tunnel release may be done with a classic open incision or with the newer endoscopic techniques.

Open Carpal Tunnel Release

The surgeon makes a 3-5 inch incision in the lower palm and wrist area. He then opens the carpal ligament and frees the median nerve. The incision is closed with stitches. A bulky bandage is applied to the wound.

Endoscopic Carpal Tunnel Release

A tiny, ½-inch incision is made on the palm side of the wrist. A miniature fiberoptic camera is passed through. This camera allows the surgeon to view the inside of the carpal tunnel on a monitor in the operating room. Another tiny incision is made, into which surgical instruments are passed. While looking at the monitor, these instruments are used to release the carpal ligament and free the median nerve. After the camera and instruments are removed, a few stitches are necessary to close the incisions. A bulky bandage is placed over the wounds.

Endoscopic Release of Carpal Tunnel

© 2008 Nucleus Medical Art, Inc.

After Procedure

Your hand and wrist will be wrapped in a bulky bandage and elevated to control swelling. Ice packs may be applied periodically.

How Long Will It Take?

The procedure takes about 15-60 minutes.

Will It Hurt?

Anesthesia prevents pain during the procedure. Once the anesthesia wears off you will experience some pain and tenderness in the area of the incision(s).

Possible Complications

If there are any problems during the endoscopic procedure, the surgeon may need to change to the traditional open procedure.

Some complications include:

  • Infection
  • Bleeding
  • Swelling
  • Nerve damage
  • Stiffness of the fingers
  • Continued numbness, tingling, weakness, or pain

Average Hospital Stay

A hospital stay is not required.

Postoperative Care

  • Keep your hand elevated as much as possible for several days to decrease swelling and pain.
  • Apply an ice pack to your wrist and hand for 20 minutes at a time, every 3-4 hours over the first couple of days after your procedure.
  • If your bandage becomes soiled, your surgeon may advise you to change it or may ask you to see him or her.
  • Do not lift heavy things or strain the hand and arm until you are advised that you may do so by your surgeon.
  • Return to your surgeon in 7-10 days to have the stitches removed.
  • Follow the exercise program recommended by your surgeon once you've begun to heal.
  • Arrange to have help around the house, especially if you've had both hands operated on.
  • Many cases of carpal tunnel syndrome are believed to occur due to repetitive actions (often occupational injury). Check with your doctor about how to prevent a recurrence.

Outcome

You may have to wear a brace or splint for several weeks after surgery.

Complete recovery may take four weeks or longer. But usually rather quickly, the numbness or tingling in your hand and fingers will improve. Your grasp strength will very slowly begin to improve. You may be given special exercises or be advised to attend physical therapy to further improve the strength and mobility of your hand and fingers.

Call Your Doctor If Any of the Following Occurs

  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Nausea and/or vomiting that you can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Signs of infection, which include fever, chills, or increased pain
  • Pain that you can't control with the medications you've been given
  • Increased tingling or weakness in your hand
  • Cough, shortness of breath, or chest pain

RESOURCES:

American Academy of Orthopedic Surgeons
http://www.aaos.org

Familydoctor.org
http://familydoctor.org

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://www.coa-aco.org/

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

Campbell's Operative Orthopaedics . 9th ed. Mosby-Year Book; 1998.



Last reviewed April 2008 by Robert E. Leach, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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