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Carpal Tunnel Syndrome

Surgery For Carpal Tunnel Syndrome

Last modified: 
20/03/2012 - 17:52

Contributing Author: Guy Slowik FRCS

Surgery is reserved as a last resort if:

  • Other treatments fail
  • Hand function continues to deteriorate

In most people, surgery completely abolishes the symptoms of CTS. However, you should be aware that:

  • In long-standing cases, if the nerve has suffered irreversible damage and is no longer able to function normally, loss of sensation and weakness in the fingers will persist. Fortunately, this is rare.
  • A few people experience a return of CTS symptoms after a period of time.

Symptoms such as pain and tingling in the hand and nighttime symptoms usually disappear soon after surgery. Numbness in the palm and fingers may take longer.

The types of surgery for carpal tunnel syndrome are:

Open Carpal Tunnel Release Surgery

The goal of this procedure is to increase the space in the carpal tunnel in order to remove pressure on the median nerve, which is compressed in the tunnel at the wrist. This operation is relatively simple and is usually done on an outpatient basis.

It may be performed with either:

  • local anesthetic, with injection of a numbing substance directly into the hand where the incision is to be made
  • regional anesthetic, with injection of a numbing substance into the upper arm to numb the entire arm
  • general anesthesia, with the patient asleep

The procedure involves dividing the ligament that forms the roof of the tunnel. This allows the nerve to pass freely through the tunnel without being compressed.

  • A tourniquet may be placed over the upper arm to limit bleeding. This will allow a clear, unobstructed view of the nerve.
  • An incision, about one and a half to two inches long, is made in the palm, usually in the skin crease, extending up to the wrist.
  • The ligament is exposed and then carefully divided - that is, it is opened along its length, making the median nerve entirely visible in the tunnel.
  • The nerve is carefully inspected to be sure it is free along its length in the tunnel and not obstructed.
  • The wound is then closed.

After the operation:

  • The hand may be dressed with bandages and a splint or plaster cast, usually for up to a week or two. The arm should be elevated to reduce swelling, and a sling may be worn for comfort. Avoid leaving the hand hanging down, since this position encourages swelling to remain in the hand.
  • It is best to remove the arm from the sling every few hours to move the elbow and shoulder so they don't get stiff. Move the fingers regularly.
  • Be careful not to wet the dressing. Cover the dressing with a plastic bag when washing.
  • Sutures are usually removed after a week to 10 days. Some surgeons prefer to use absorbable sutures or adhesive tape.
  • Once the dressings are removed, you will be encouraged to move the hand and fingers. You'll begin with gentle gripping exercises, first with the palm empty and then with a soft sponge in the palm. Some physicians will arrange a supervised hand therapy program.
  • Many physicians recommend massaging the scar with oil or cream.

Need To Know:

Getting back to work

An individual may return to work anywhere from two to eight weeks after surgery. This depends on:

  • The severity of the condition
  • The type of surgery performed
  • Progress in rehabilitation
  • The nature of the person's work

Those whose work involves repetitive motion or continuous strenuous hand activity may need to recover for at least six to ten weeks.

More than 100,000 open release procedures are performed every year. Complications are extremely rare. Very few patients feel discomfort from the scar tissue.

Endoscopic Or "Keyhole" Surgery

A newer procedure using a very small incision at the wrist allows the surgeon to pass fiber-optic tools through an endoscope (a device consisting of a pencil-thin tube and an optical system) into the tunnel. Then, using specialized tiny instruments, the surgeon divides the ligament. The surgeon views the carpal tunnel area and the median nerve on a video monitor.

The advantages of endoscopic surgery are that recovery time is quicker and the scar is smaller. However, since this is a newer procedure, not all surgeons are experienced with it. Therefore, the success rate may be a little lower than the conventional technique and the complication rate higher.

"Keyhole" surgery for carpal tunnel syndrome has its opponents as well as proponents. It is important to select a surgeon with expertise in this procedure.

Nice To Know:

Percutaneous Balloon Carpal Tunnelplasty

A few surgeons are trying a new procedure to increase the space in the carpal tunnel. This procedure is similar to balloon angioplasty, a common procedure in which arteries of the heart are widened with a tiny balloon. But it has not yet been shown to be effective in carpal tunnel syndrome and has not been accepted by mainstream hand surgeons.

Here's how it's done:

  • The surgeon makes a small incision at the base of the palm, then introduces a thin tube, to which a balloon is attached, into the carpal tunnel.
  • The tiny balloon is inflated under the ligament.
  • The balloon stretches the ligament without the need to cut it, thereby widening the space in the tunnel.

After surgery, the doctor will advise a gradual rehabilitation program of physical therapy to regain strength and flexibility in the hand, wrist, and forearm. One simple exercise involves squeezing a wet sponge.

 

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Carpal Tunnel Syndrome

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.