Carpal Tunnel Release

• Carpal tunnel decompression, popularly referred to as carpal tunnel release, is a surgical procedure conducted to relieve symptoms of carpal tunnel syndrome.
• A nerve called median nerve along with many tendons pass through a small tunnel called carpal tunnel from the forearm to the upper hand. This nerve controls the movement of your fingers except for the little finger.
• Sometimes there is tremendous pressure on the nerve and it presses the nerve against the tunnel. This results in specific symptoms such as numbness, weakness, tingling sensation, or pain in the fingers. This is known as carpal tunnel syndrome.
  
  
  

Is carpal tunnel surgery compulsory?

The treatment for carpal tunnel syndrome depends on the severity of the condition and the duration of the symptoms. Generally, the physicians first recommend non-surgical interventions such as the use of corticosteroid injections and wrist splints to relieve the symptoms of carpal tunnel syndrome.

A carpal tunnel treatment surgery is recommended in case:

• You experience loss of function in fingers or hand because of nerve damage confirmed in a median nerve test.
• Your symptoms do not subside. Wait for two to seven weeks after starting non-surgical treatment.
• You have difficulty in performing daily activities ranging from reduced strength in the thumb, loss of feeling, and loss of coordination.
• You are not able to get sleep properly because of the pain.
• The main cause of this situation is rheumatoid arthritis.

The carpal tunnel treatment surgery is an open technique. The surgeon may make a cut in the transverse carpal ligament that forms the roof of the tunnel. The carpal tunnel treatment allows more room for the median nerve and the tendons to pass through the tunnel. Thereby, the pressure on the nerve is reduced causing relief from the symptoms.

Carpal tunnel surgery is a simple outpatient procedure. You can go to the hospital, get the surgery done, and walk back to home on the same day.

On the day of the surgery, the area to be operated is cleaned with an antiseptic solution to avoid the chances of contracting an infection. The anesthetist administers a local anesthetic injection to numb the wrist area. This is done so that you do not experience any pain during the procedure.

A small cut is made in the palm near to the wrist area. Once the transverse carpal ligament is visible, a small cut is made in the ligament. This relieves the pressure on the nerve. The skin is put back and stitched together in its original position. A bandage is placed on the palm.

Are there any other techniques?

The following are the two alternatives to the open carpal tunnel surgery:

Endoscopic carpal tunnel surgery: The surgical procedure is similar to that of open surgery but the entire surgery is performed by looking at the camera. A small incision is made and small instruments with a camera attached to them are placed inside. The incision is small and damage is minimal. It gives you a chance to recover faster than the open technique. The healing is better and minimal pain is felt.

Key hole surgery: In this procedure, a smaller incision than normal is made on the palm. A special instrument with a light at one end and microscope at the other end is placed. This gives the doctor a chance to see the carpal ligament and carefully guide the tools to cut the targeted area.

The symptoms are usually relieved immediately after the surgery or in most cases, within a few months. You may feel numbness in the fingers for the next 15 to 16 hours.

• Keep your hand in a raised position for two days so that there is no swelling.
• The stitches and the bandage should be kept intact for 10 to 14 days. Make sure that you keep the area clean and dry.
• The doctor will fix the next appointment after two weeks of bandage removal during which he or she will inspect the healing process.
• You have to go through the rehabilitative physical therapy that includes mild exercises to prevent stiffness.

The time you take to recover from carpal tunnel surgery depends on the severity of symptoms you had before the treatment.

• If you had moderate symptoms, on the non-dominant hand, or your daily activities are limited, you can recover in one or two days.
• If you had moderate to severe symptoms, on the dominant hand, or your daily activities are intensive, you may have to wait for 6 to 12 weeks to recover completely.

Does it come back?

• In very rare cases, symptoms such as pain and numbness may come back
• You may not get back complete strength in the thumb if the muscles have been severely damaged