Carpal tunnel syndrome (CTS) develops when the median nerve, which extends from the forearm into the hand, becomes compressed within a narrow passageway in the wrist called the carpal tunnel. This condition can lead to symptoms such as pain, tingling, and numbness in the thumb, index, middle, and half of the ring finger. When conservative treatments like wrist splints, physical therapy, or steroid injections do not provide sufficient relief, surgical intervention may become a necessary option. The goal of surgery is to alleviate pressure on the median nerve to improve hand function and reduce discomfort.
Preparing for the Procedure
Before carpal tunnel surgery, patients generally undergo preparatory steps to ensure readiness. Pre-operative appointments often include medical evaluations like blood tests or an EKG to assess overall health. Patients discuss the procedure with their surgeon and anesthesiologist to determine the most suitable type of anesthesia. Specific instructions are provided regarding fasting, typically requiring no food or drink after midnight the night before surgery, though small sips of water for medication may be permitted.
Medication adjustments are frequently necessary, especially for blood thinners, which may need to be stopped or altered a few days before the operation to reduce bleeding risks. Patients are advised to arrive wearing loose-fitting clothing, as a bulky dressing or splint will be applied to the wrist after surgery. Anesthesia options for carpal tunnel surgery include local anesthesia (numbing the hand and wrist), local anesthesia with sedation, or general anesthesia. The choice is made based on patient health and the surgical approach.
The Surgical Process
Carpal tunnel release surgery begins with the patient positioned to allow clear access to the affected wrist, typically with the arm extended on a hand table. Once the chosen anesthesia is administered, the surgical team proceeds with the incision. The primary objective of the surgery is to divide the transverse carpal ligament, which forms the roof of the carpal tunnel, thereby creating more space for the median nerve and relieving compression.
Two main surgical approaches are used: open carpal tunnel release and endoscopic carpal tunnel release. In an open release, the surgeon makes a 1 to 2-inch incision at the base of the palm. Through this incision, the surgeon visualizes and cuts the transverse carpal ligament. This traditional method allows for a clear view of the median nerve and surrounding structures.
Alternatively, endoscopic carpal tunnel release involves one or two smaller incisions, typically less than an inch, either in the wrist or at the wrist and palm. An endoscope (a thin tube with a camera) is inserted through one incision to provide a magnified view of the carpal tunnel on a monitor. Tiny cutting tools are then inserted through the same or another small incision to divide the transverse carpal ligament. Both techniques decompress the median nerve. After the ligament is divided, the incision is closed with sutures or surgical tape, and a sterile dressing is applied.
Immediate Post-Surgery Care
After carpal tunnel surgery, the patient is moved to a recovery room for monitoring. During this immediate post-operative phase, medical staff observe vital signs and assess for any effects of the anesthesia. Initial pain management strategies are implemented, which may involve administering prescribed pain medication to alleviate discomfort. The surgical site is also checked for bleeding or swelling.
Patients receive initial care instructions before discharge. Keeping the hand elevated above heart level is advised to reduce swelling and promote circulation. Instructions for managing pain with prescribed medications are provided, along with guidance on keeping the dressing clean and dry to prevent infection. Carpal tunnel release is commonly performed as an outpatient procedure, meaning most patients return home the same day after recovering from anesthesia. Patients must arrange for someone to drive them home, as they will not be able to drive themselves.