Carpal Tunnel ReleaseBy
Catherine Spader, RN
What is a carpal tunnel release?
Carpal tunnel release is a surgery to treat carpal tunnel syndrome. Carpal tunnel syndrome is a common disorder caused by compression of the median nerve in the wrist. It can lead to pain, numbness, and sometimes disability of the hands. Carpal tunnel surgery involves relieving pressure on the median nerve by cutting part of the carpal ligament. This band of tissue holds the wrist joint together.
Carpal tunnel release is a common surgery but has risks and potential complications. Your doctor will probably recommend less invasive treatment options for carpal tunnel syndrome before considering carpal tunnel release for you. Consider getting a second opinion about all of your treatment choices before having a carpal tunnel release.
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Why is carpal tunnel surgery performed?
Your doctor may recommend a carpal tunnel release procedure to treat carpal tunnel syndrome. Carpal tunnel syndrome is often associated with repetitive actions of the hands and wrists. Examples include long-term keyboarding, use of vibrating tools, or assembly line jobs.
These actions can cause swelling and increased pressure on the median nerve over time. This can lead to pain and numbness that can become disabling. Other conditions that are linked to carpal tunnel syndrome include diabetes, pregnancy, menopause, a hand or wrist injury, and rheumatoid arthritis.
Doctors generally do not consider carpal tunnel release surgery unless less invasive treatments have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on carpal tunnel release. Other treatments include:
Acupressure and acupuncture, which may help reduce pressure on the median nerve
Anti-inflammatory medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and aspirin. NSAIDs treat carpal tunnel syndrome effectively, but long-term use can cause serious side effects. These include bleeding stomach ulcers and kidney problems. You should only take NSAIDs as directed by your healthcare provider.
Changing or limiting repetitive motion or jarring activities of the hands and wrists. These include typing, keyboarding, sewing, performing dental work, and using a chainsaw or jackhammer.
Corticosteroids to reduce the inflammation and pain of carpal tunnel syndrome. Corticosteroids are usually given through an injection into the carpal tunnel of the wrist.
Ensuring that keyboards are placed low enough so that wrists are not flexed while working
Not flexing the wrists for long periods of time. For example, your doctor may recommend that you wear a wrist brace at night to prevent your wrists from flexing while you are sleeping.
Seeking regular medical care and following your treatment plan for underlying conditions. Conditions include acromegaly, diabetes, hypothyroidism, pregnancy, rheumatoid arthritis, and hand and wrist trauma and fractures.
Who performs carpal tunnel release?
The following specialists perform carpal tunnel release:
Hand surgeons specialize in medical and surgical treatment of the structures of the hand, wrist, forearm and elbow.
Neurosurgeons specialize in the medical and surgical care of diseases and conditions of the brain and nervous system.
Orthopedic surgeons specialize in the medical and surgical treatment of diseases and conditions of the bones, muscles and joints.
Plastic surgeons specialize in using surgery to correct conditions that affect a person's ability to function or appearance.
How is carpal tunnel release performed?
Your carpal tunnel release will be performed in a hospital or outpatient setting. It is usually an outpatient surgery.
Your surgeon will make an incision in the wrist and cuts into the carpal ligament. This enlarges the space in the carpal tunnel and relieves pressure on the median nerve. The surgery takes about an hour, depending on the surgical approach.
Surgical approaches to a carpal tunnel release
Your surgeon will perform your carpal tunnel release using one of the following approaches:
Minimally invasive surgery, or endoscopic carpal tunnel release, is performed by inserting special instruments and an endoscope through one or two small ½-inch incisions in the wrist. The endoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of the wrist to a video screen. Your surgeon sees the surgical area on the video screen while performing the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision(s) instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.
Open surgery is performed by making a two inch incision in the wrist. Open surgery allows your surgeon to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different carpal tunnel procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform carpal tunnel release using either general anesthesia or regional anesthesia, depending on the specific procedure.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and do not feel any pain.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb an area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable. This is the most common type of anesthesia used for carpal tunnel release.
What to expect the day of your carpal tunnel release
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form. You should verify the correct site with the surgical staff.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have. The surgeon will perform some types of nerve blocks.
Your team will start an IV and clean your wrist, hand and arm.
The anesthesiologist, nurse anesthetist, or surgeon will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
Your surgeon will make an incision on the palm side of the wrist and cut the carpal ligament. The incision is closed with stitches.
Your team will apply a dressing and splint to your wrist.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and all vital signs are stable.
What are the risks and potential complications of carpal tunnel surgery?
As with all surgeries, carpal tunnel release involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
Complications of carpal tunnel release are uncommon but include:
Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing
Delayed return to work
Loss of wrist strength
Stiffness or pain of the incision scar
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your surgery and during recovery. This includes following up with physical therapy and occupational therapy as recommended.
Informing your doctor if you are nursing or if there is any possibility that you may be pregnant
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my carpal tunnel release?
You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome.
You can prepare for carpal tunnel release by:
Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Arranging for a ride home
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Having a carpal tunnel release can be stressful. It is common for patients to forget some of their questions during the doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is a good idea to bring a list of questions to your appointments. Common questions include:
Why do I need carpal tunnel release? Are there any other options for treating my condition?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How should I take my medications?
How will you manage my pain?
What type of physical therapy and occupational therapy might I need?
When should I follow-up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after carpal tunnel surgery?
Knowing what to expect can help make your road to recovery after carpal tunnel release as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are fully alert, breathing effectively, and your vital signs are stable. You will probably go home on the same day.
You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. You may need to wear a wrist brace for several weeks. Follow your physical therapy and occupational therapy exercises for optimal recovery. Full recovery takes several months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. Patients often feel immediate relief of severe pain after their surgery, but still feel soreness in the palm for several months. You may have some swelling and stiffness after surgery, which should gradually decrease. You may also have decreased grip and pinch strength for a couple of months.
Your doctor will treat your pain so you are comfortable. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after carpal tunnel release. Follow up with physical therapy and occupational therapy as directed. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Difficulty moving arm, hand or wrist as expected
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Numbness or tingling of the arm or hand
Pain that is not controlled by your pain medication or increase or change in pain
Swelling of stiffness of the hand that gets worse or does not get better
Unexpected drainage, pus, redness or swelling of your incision
How might carpal tunnel surgery affect my everyday life?
Carpal tunnel release may cure your condition or significantly reduce your symptoms so you can lead an active, independent life. You may need to adjust or change the type of work you do, such as work that involves vibrating tools or long periods of keyboarding.
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- Carpal Tunnel Release. Southern California Orthopedic Institute. http://www.scoi.com/ctr.htm
- Carpal Tunnel Syndrome. American Academy of Orthopedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00005
- Carpal Tunnel Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm
- Endoscopic Carpal Tunnel Release (ECTR). The Hand and Wrist Institute at DISC. http://www.handandwristinstitute.com/carpal-tunnel-release-surgery-los-angeles/