Carpal Tunnel Surgery

The carpal tunnel is a narrow hollow area in the wrist. It is formed by the wrist bones and ligaments. Nerves, blood vessels, and tendons on the palm side of your hand pass through the carpal tunnel. (The palm side is the side of your hand in the direction your fingers bend.) Repeated wrist motion or certain diseases may cause swelling within the tunnel. That is why these are sometimes called repetitive trauma disorders. It is also a common problem in late pregnancy because of water retention. This swelling pinches the main nerve in the wrist (median nerve). It causes the painful condition called carpal tunnel syndrome. A feeling of "pins and needles" may be noticed in the fingers or hand. The entire arm may ache from this condition. Carpal tunnel syndrome may clear up by itself. Cortisone injections may help. An electromyogram may be needed to confirm this diagnosis. This is a test which measures nerve conduction. The nerve conduction is usually slowed in a carpal tunnel syndrome. Sometimes, an operation may be needed to free the pinched nerve.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies

  • Medications taken including herbs, eye drops, over the counter medications, and creams

  • Use of steroids (by mouth or creams)

  • Previous problems with anesthetics or novocaine

  • Possibility of pregnancy, if this applies

  • History of blood clots (thrombophlebitis)

  • History of bleeding or blood problems

  • Previous surgery

  • Other health problems

RISKS AND COMPLICATIONS

  • Infection: A germ starts growing in the wound. This can usually be treated with antibiotics.

  • Damage to other organs may occur.

  • Bleeding following surgery can be a complication of almost all surgeries. Your surgeon takes every precaution to keep this from happening.

  • Recurrence (return) of carpal tunnel syndrome following treatment is rare.

BEFORE THE PROCEDURE

  • Stop smoking at least two weeks prior to surgery. This lowers risk during surgery.

  • Stop non steroidal medicine for ten days prior to surgery. Also, do not take aspirin unless OK'd by your surgeon.

  • Your caregiver may tell you to stop taking certain medicine that may affect the outcome of the surgery and your ability to heal. For example, you may need to stop taking anti-inflammatories, such as aspirin, because of possible bleeding problems. Other medicine may have interactions with anesthesia.

  • BE SURE TO LET YOUR CAREGIVER KNOW IF YOU HAVE BEEN ON STEROIDS (INCLUDING CREAMS) FOR LONG PERIODS OF TIME. THIS IS CRITICAL.

  • Your caregiver will discuss possible risks and complications with you before surgery. In addition to the usual risks of anesthesia, other common risks and complications include:

  • Temporary increase in pain due to surgery.

  • Uncorrected pain.

  • Infection.

You should be present 60 minutes before your procedure or as directed.

PROCEDURE

  • Carpal tunnel release is generally recommended if symptoms last for 6 months. Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay. Many patients require surgery on both hands. The following are types of carpal tunnel release surgery:

  • Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.

  • Endoscopic surgery may allow faster functional recovery and less post-operative discomfort than traditional open release surgery. The surgeon makes two incisions (cuts) (about 1/2 inch each) in the wrist and palm, inserts a camera attached to a tube, looks at the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. One-portal endoscopic surgery for carpal tunnel syndrome is also available.

Although symptoms may be better right after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Sometimes the wrist loses strength because the carpal ligament is cut. Patients should take part in physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.

The majority of patients recover completely without complications (additional problems).

AFTER THE PROCEDURE

After surgery, you will be taken to the recovery area where a nurse will watch and check your progress. Once you're awake, stable, and taking fluids well, without other problems you will be allowed to go home.

HOME CARE INSTRUCTIONS

  • Once at home, an ice pack applied to your operative site may help with discomfort and keep the swelling down.

  • Follow your caregiver's instructions as to activities, exercises, physical therapy, and driving a car.

  • Maintain strength and range of motion as instructed.

  • If you were given a splint to keep your wrist from bending, use it as instructed. It is important to wear the splint at night. Use the splint for as long as you have pain or numbness in your hand, arm or wrist. This may take 1 to 2 months.

  • If you have pain at night, it may help to elevate your hand above the level of your heart (the center of your chest).

  • It is important to avoid activities which originally caused your carpal tunnel syndrome for a couple weeks following surgery, or as directed by your surgeon. If your symptoms are work-related, you may need to talk to your employer about changing to a job that does not require using your wrist.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

  • Following periods of extended use, particularly hard (strenuous) use, apply an ice pack wrapped in a towel to the palm (anterior) side of the affected wrist for 20 to 30 minutes. Repeat as needed three to four times per day. This will help reduce swelling following surgery.

SEEK MEDICAL CARE IF:

  • There is increased bleeding (more than a small spot) from the wound.

  • You notice redness, swelling, or increasing pain in the wound.

  • Pus is coming from wound.

  • An unexplained oral temperature above 102° F (38.9° C) develops.

  • You notice a foul smell coming from the wound or dressing.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop a rash.

  • You have difficulty breathing.

  • You have any problems you think are related to allergies.