Carpal Tunnel Syndrome Repair

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Definition | Body Parts Involved | Reasons for Procedure | Complications | What to Expect | Outcome | Call Doctor If

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Definition

Surgery to relieve pressure on the median nerve in the wrist. Carpal tunnel syndrome is caused by pressure on the median nerve, which occurs when people use their hands and wrists repeatedly in the same way.

Parts of the Body Involved

Palm and/or wrist

Reasons for Procedure

The median nerve passes through the wrist and into the hand through the carpal tunnel. The carpal tunnel is made up of the bones of the wrist and a thick, fibrous ligament called the transverse carpal ligament. When this ligament becomes inflamed, it puts pressure on the median nerve, causing it to malfunction. This results in numbness and tingling in the hand and fingers, and a weakening of the hand's grasp, and is called carpal tunnel syndrome.

Surgery to treat carpal tunnel syndrome is usually recommended in these cases:

• Other therapies have failed, including icing, splints or braces, anti-inflammatory medications, steroid injections, physical therapy, ultrasound, or laser light therapy
• There is Shrinkage (atrophy) and weakness of the muscles controlling the thumb
• Studies of nerve functioning reveal that the median nerve is malfunctioning due to its compression within the carpal tunnel

Risk Factors for Complications during the Procedure

• Obesity
• Smoking
• Alcoholism
• Diabetes

What to Expect

Prior to Procedure

Your doctor will likely do the following:

• Physical exam, concentrating on strength and sensation in the affected hand or hands
• Nerve conduction studies
• Electromyogram (EMG) – a recording of the electrical currents generated in an active muscle
• MRI scan (rarely done) – a test that uses magnetic waves to make pictures of the inside of the body

In the days leading up to your procedure:

• Arrange for a ride to and from the procedure
• Arrange for help at home after the procedure
• The night before, eat a light meal and do not eat or drink anything after midnight
• You may be asked to shower the morning of your procedure, and you may be given special antibacterial soap to use

During Procedure – Anesthesia or sedation

Anesthesia - General, or local with sedation

Description of the Procedure - Carpal tunnel repair may be done with a classic open incision or with newer endoscopic techniques:

Open carpal tunnel release: The surgeon makes a 3-5 inch incision in the lower palm, opening the carpal ligament and freeing the median nerve. The palm incision is then closed with stitches, and a bulky bandage is applied to the wound.

Endoscopic carpal tunnel release: A tiny, 1/2- inch incision is made on the inside of the wrist, through which a miniature fiberoptic camera is passed. This camera allows the surgeon to view the inside of the wrist on a monitor in the operating room. Another tiny incision is made, into which surgical instruments are passed. These instruments are used to open the carpal ligament and free the median nerve. After the camera and instruments are removed, a few tiny stitches are necessary to close the incisions, and a bulky bandage is placed over the wounds.

After Procedure - Your hand and/or wrist will be wrapped in a bulky bandage and elevated to control swelling. Ice packs may be applied periodically.

How Long Will It Take? 15-60 minutes

Will It Hurt? Anesthesia prevents pain during the procedure, but once the anesthesia wears off you will experience some pain and tenderness in the area of the incision(s).

Possible Complications:

• During the endoscopic procedure, if there are any complications, the surgeon may need to revert to the traditional open carpal tunnel release
• Infection
• Bleeding
• Swelling
• Nerve damage
• Stiffness
• Continued numbness, tingling, weakness, or pain
• Recurrence of carpal tunnel syndrome

Average Hospital Stay -None

Postoperative Care:

• Keep your hand elevated for several days, to decrease swelling and pain
• Apply an ice pack to your wrist and hand for 20 minutes at a time, every 2-3 hours over the first couple of days after your procedure
• Change the bandage daily, and apply antibiotic ointment to the incision, if advised by your doctor
• Do not lift heavy things or strain the hand and arm, until you are advised that you may do so by your surgeon
• Return to your surgeon in 7-10 days to have the stitches removed
• Follow the exercise program recommended by your surgeon once you've begun to heal
• Arrange to have help around the house, especially if you've had both hands operated on
• Since many cases of carpal tunnel syndrome are believed to occur due to repetitive motion strains (often occupational injury), check with your doctor about how to prevent a recurrence

Outcome

You may have to wear a brace or splint for several weeks after surgery.

Complete recovery may take four weeks or longer. You should no longer have numbness or tingling in your hand and fingers, and your grasp strength should begin to improve. You may be given special exercises or be advised to attend physical therapy in order to further improve the strength in your hand and fingers.

Call Your Doctor If Any of the Following Occurs

• Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
• Nausea and/or vomiting that you can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
• Signs of infection, including fever and chills
• Pain that you can't control with the medications you've been given
• Pain, tingling, or weakness in your hand
• Cough, shortness of breath, chest pain, or severe nausea or vomiting

SOURCES:

Campbell's Operative Orthopaedics, 9th ed. Mosby-Year Book, 1998.

The Center for Orthopaedics and Sports Medicine

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Last reviewed February 2001 by Medical Review Board