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 (something that runs in families) – 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 (or inside) 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.

Why might I need carpal tunnel surgery?

A diagnosis of carpal tunnel syndrome is about the only reason to have a carpal tunnel surgery. And even then, your doctor 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, or shots of steroids in the wrist to help relieve swelling and pain.

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

• The nonsurgical interventions for carpal tunnel syndrome don't relieve the pain.
• The doctor performs an electromyography test of the median nerve and determines that you have carpal tunnel syndrome.
• The muscles of the hands or wrists are weak and actually getting smaller because of the severe pinching of the median nerve.
• The symptoms of carpal tunnel syndrome have lasted 6 months or longer with no relief.

What are the risks of carpal tunnel 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 when drugs 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 recovery from carpal tunnel surgery takes time – anywhere from several weeks to several months. If the nerve has been compressed for a long period of time, recovery may take even longer. 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. Be sure to discuss any concerns with your doctor before the procedure.

How do I get ready for carpal tunnel surgery?

• Tell your doctor about all medicines you are currently taking, including over-the-counter drugs, 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 to the surgery. Smoking can delay healing.
• You may need to get blood tests or an electrocardiogram (ECG) before surgery.
• You will usually be asked not to eat or drink anything for 6 to 12 hours before the surgery.

Based on your medical condition, your doctor may request other specific preparations.

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 (cut). 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:

1. You will usually be asked to remove your clothing, or at least your shirt, and put on a hospital gown.
2. Typically, local anesthetic is used for this procedure to numb the hand and wrist.
3. 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.
4. 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.
5. The surgeon will stitch up the incision or incisions.
6. 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 monitored for a short time, and then allowed to go home. Only in rare cases or complications is an overnight stay needed for a carpal tunnel release surgery.

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.

Next steps

Before you agree to the test or the 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 will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure