Carpal Tunnel Release

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.

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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.

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.

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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.

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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.