What You Need To Know About Carpal Tunnel Syndrome Surgery

• What Is Carpal Tunnel Release?

• Why Is Surgery for Carpal Tunnel Performed?

• Types of Carpal Tunnel Surgery and Treatments

• How to Prepare for Carpal Tunnel Surgery

• What Happens During Carpal Tunnel Surgery?

• Carpal Tunnel Surgery Risks

• Recovering From Carpal Tunnel Surgery

• When To Content Your Carpal Tunnel Specialist

What Is Carpal Tunnel Release?

Carpal tunnel release is designed to alleviate symptoms of carpal tunnel syndrome by releasing pressure on the median nerve of the wrist. This pressure creates the hand pain and weakness associated with CTS and is typically caused by swelling in the carpal tunnel, a narrow passageway in the wrist. Carpal tunnel symptoms can be congenital or related to repetitive use, wrist injury, or conditions like diabetes.

Carpal tunnel release surgery involves cutting the carpal ligament to enlarge the tunnel and relieve pressure on the nerve. This procedure is typically considered when less invasive treatments haven't provided relief.

Why Is Surgery for Carpal Tunnel Performed?

Carpal tunnel release surgery is primarily performed when non-surgical treatments for CTS—like medications, physical therapy, wrist splints, or steroid injections—fail to relieve symptoms. This procedure is recommended when:

• Non-surgical interventions don't alleviate the pain.

• Diagnostic tests, such as EMG, confirm CTS.

• There is evident muscle weakness or atrophy in the hands or wrists due to nerve compression.

• Symptoms persist for 6 months or more without improvement.

Types of Carpal Tunnel Surgery and Treatments

The course of your CTS treatment is determined by the severity of your symptoms. Mild to moderate cases of carpal tunnel may benefit from a variety of non-surgical treatments, such as icing, OTC pain relievers, rest, or a wrist splint, while more severe cases may require CTS surgery.

Carpal Tunnel Treatment Without Surgery

Most patients begin carpal tunnel treatment without surgery, which is typically reserved for severe cases that don't improve after non-surgical interventions. Some common options for non-surgical CTS treatment include:

• Rest: It can help to reduce or stop repetitive activities that trigger your carpal tunnel symptoms when possible. Also, try to plan for longer periods of rest between activities that stress your wrist.

• Improve wrist strength and mobility: Your carpal tunnel specialist may recommend certain stretches or exercises to help improve the mobility and strength of your forearm. These activities may help reduce your CTS symptoms.

• Ice therapy: Ice can reduce swelling in the wrist and take pressure off your median nerve. If you are experiencing CTS pain, try icing your wrist for 10-15 minutes every hour.

• Address muscular imbalances: Your doctor may recommend massage treatment or physical therapy to address some of the underlying muscular issues that may be contributing to your carpal tunnel symptoms.

• Use a wrist splint: A wrist splint will immobilize your wrist and keep it in a straight and neutral position. Wearing one at night can help improve your CTS symptoms over time.

• Reduce inflammation: Trying an anti-inflammatory diet or adding B6 or B12 supplements to your diet can help with carpal tunnel syndrome, although you should first discuss any medical or dietary changes with your carpal tunnel specialist.

• Cortisone injections: The steroid cortisone can help some patients experience relief from carpal tunnel pain, but it is not effective (or as effective) for everyone. Before taking this step, your doctor will discuss some important details and potential complications that you should be aware of.

Surgical Approaches to CTS

For some patients, even careful adherence to a non-surgical treatment plan won't resolve their CTS pain. If your doctor is concerned about the possibility of long-term muscle atrophy or nerve damage in your wrist, then they may recommend a carpal tunnel release surgery.

This procedure involves cutting and releasing the wrist ligament to create more space for the median nerve. There are two primary approaches to CTS surgery:

Open Approach

During an open carpal tunnel release surgery, your surgeon will take a traditional approach and cut the wrist ligament from the outside in.

Endoscopic Approach

In an endoscopic approach, your carpal tunnel surgeon cuts the wrist ligament from the inside out using advanced surgical tools. This minimally invasive surgery uses a smaller incision, and patients generally experience less pain and faster recovery times.

It's important to remember that early detection of carpal tunnel syndrome will improve the chances of a speedy recovery. If you're experiencing pain, numbness, or weakness in the wrist and hands, consider seeing a doctor as soon as possible. Schedule your appointment with one of the carpal tunnel specialists at Resurgens Orthopaedics today!

How to Prepare for Carpal Tunnel Surgery

You can help ensure a successful carpal tunnel procedure by following all of your doctor's pre-surgery instructions. Generally, those steps include:

• Inform your doctor about any medications you're taking, including over-the-counter drugs and supplements.

• Stop medications that can affect blood clotting, like aspirin or ibuprofen, and attempt to quit or limit smoking to aid healing.

• Pre-surgery, you might need blood tests or an ECG, and fasting 6 to 12 hours before is common.

• Follow specific instructions for showering with antiseptic soap, and avoid lotions or perfumes.

• Arrange transportation home post-surgery, as anesthesia affects your ability to drive.

Remember: If you have any questions or concerns about how to prepare for your surgery, you should contact your carpal tunnel specialist.

What Happens During Carpal Tunnel Surgery?

Before your carpal tunnel release procedure begins, the surgical team will carefully mark the correct area for surgery, and your anesthetist will make sure you feel comfortable during the procedure. Depending on your specific circumstances, they may just numb the surgical area or put you to sleep entirely. Most carpal tunnel release surgeries are completed within 15 to 60 minutes.

Open Approach

The general steps for an open approach CTS surgery include:

• Pre-surgical prep: Your carpal tunnel surgeon will give you a set of instructions to follow, including fasting the night before your surgery. Before the procedure begins, the surgical team may use a local anesthetic to numb the surgical area or a general anesthetic to put you to sleep. Your care team will discuss your options with you prior to the procedure.

• Incision: Your carpal tunnel surgeon will make a 1-to-2 inch incision from the wrist to the palm of the hand to gain access to the wrist ligament.

• Carpal tunnel release: Your surgeon will make a careful cut to the ligament to open, or release, the carpal tunnel and reduce pressure on the median nerve.

• Sutures: The initial incision will be closed with a few stitches and then bandaged. Your carpal tunnel specialist may also inject some numbing medication into the surgical area to help relieve post-surgical pain, or they may recommend that you use a wrist splint for some time after the procedure.

Endoscopic Approach

An endoscopic approach CTS surgery follows slightly different steps:

• Pre-surgical prep: Similar to the open approach, you will need to follow a strict set of instructions from your doctor to prepare for the procedure. Before the procedure begins, the surgical team may use a local anesthetic to numb the surgical area or a general anesthetic to put you to sleep. Your care team will discuss your options with you prior to the procedure.

• Incision: Your carpal tunnel surgeon will create a small surgical cut and insert an endoscope, which is a tiny camera attached to a monitor that allows the surgeon to see inside your wrist.

• Carpal tunnel release: Operating from the inside out, your surgeon will make a small cut to the wrist ligament to open up your carpal tunnel and reduce pressure on the median nerve.

• Sutures: The initial incision will be closed with a few stitches and then bandaged. Your carpal tunnel specialist may also inject some numbing medication into the surgical area to help relieve post-surgical pain, or they may recommend that you use a wrist splint for some time after the procedure.

Carpal Tunnel Surgery Risks

All surgical procedures, including carpal tunnel release, come with inherent risks. These can range from general surgical risks such as bleeding, infection, and anesthesia reactions to more specific complications like:

• Injury to the median nerve or its branches

• Damage to nearby blood vessels

• Development of a sensitive scar

• Allergic reactions to medications

• Postoperative weakness or numbness in the hand

• Potential for worsening pain after the procedure

As with all major medical decisions, it's crucial to discuss these risks with your doctor to make an informed decision.

Recovering From Carpal Tunnel Surgery

Fortunately, CTS surgery is almost always an outpatient procedure, so it's unlikely that you will need to stay in the hospital after your surgery. Your carpal tunnel specialist may ask you to wear a wrist splint for 2 to 3 weeks, and we will be able to take your stitches out after 1 to 2 weeks. Most patients will then undergo a physical therapy program to help regain mobility and strength in the hand.

Your hand and wrist are likely to feel some pain and weakness for several days to several months. Most patients recover within 3-4 months, but it may take up to a year to regain your full hand strength. The timing for your return to work will depend on the type of procedure you had (endoscopic procedures generally have shorter recovery periods than open approach surgeries) and whether or not the procedure was performed for your dominant hand, but most people can expect to return to work within a couple weeks.

While recovering at home, keep these important steps in mind:

• Avoid heavy lifting and repetitive hand movements for up to 2 weeks.

• Keep the surgical site dry; cover it during showers.

• Resume driving and normal activities as comfort and control return.

• Follow a balanced diet and manage pain with prescribed medications.

• Monitor for signs of infection or unusual pain and contact your doctor with any concerns.

When To Contact Your Carpal Tunnel Specialist

Contact your doctor if you experience any of the following after CTS surgery:

• Uncontrollable pain

• Changes in hand color or temperature

• Tightness from casts or splints

• Worsening or new numbness, tingling, or weakness

• Nausea

• Issues with stitches or incisions

• Signs of infection like increased pain, swelling, redness, pus, fever, or significant bleeding through bandages

Always monitor your health closely post-surgery and reach out to your carpal tunnel specialist with any concerns or if your recovery isn't progressing as expected.