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. Healthcare providers used to think that carpal tunnel syndrome was caused by
an overuse injury or a repetitive motion done 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. It is not uncommon for a person to have carpal
tunnel in both hands.


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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. It usually
improves pain and function.

Why might I need carpal tunnel release surgery?

A diagnosis of carpal tunnel
syndrome is about the only reason to have a carpal tunnel surgery. And even then, your
healthcare provider 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
  • Shots of steroids in the wrist to help ease swelling and
    pain

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

  • The nonsurgical interventions for carpal tunnel syndrome don’t relieve the pain.
  • The healthcare provider performs an
    electromyography and nerve conduction 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 a prolonged period of time with no relief.

How do I get ready for carpal tunnel release surgery?

  • Tell your healthcare provider about
    all medicines you are currently taking, including over-the-counter medicines,
    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
    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 healthcare provider may request other specific preparations.

What happens during carpal tunnel release surgery?

Carpal tunnel release is usually an
outpatient procedure. That 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. During this surgery, a thin, flexible tube that contains a
camera is put into the wrist through a tiny incision (cut). The camera guides the
healthcare provider 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
steps 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 surgeon 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 surgeon 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 when
there are complications is an overnight stay needed for a carpal tunnel release
surgery.

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