Carpal tunnel syndrome (CTS) is a condition where the median nerve, which runs through a narrow passageway in the wrist called the carpal tunnel, becomes compressed. This compression can lead to symptoms such as pain, numbness, tingling, and weakness in the hand and fingers. When conservative treatments like splinting, medication, or physical therapy do not provide sufficient relief, surgery often becomes a consideration. Carpal tunnel release surgery aims to alleviate pressure on the median nerve, improving symptoms and preventing further nerve damage.
Before the Operation
Diagnosing carpal tunnel syndrome begins with a physical examination, assessing sensation in the fingers and hand muscle strength. They may also ask about the pattern of symptoms, as CTS often causes numbness or tingling at night or when gripping objects. If the diagnosis is unclear or to determine the extent of nerve involvement, a nerve conduction study might be performed. This test measures how quickly electrical impulses travel through the median nerve, identifying any slowing within the carpal tunnel.
Surgery is considered when symptoms are severe, persistent, or have not responded to non-surgical interventions. This includes cases where there is muscle wasting at the base of the thumb or constant numbness and pain that disrupts sleep. Preparing for the procedure involves a medical evaluation to assess overall health and discuss any existing conditions. Patients are advised to inform their surgeon about all medications, including over-the-counter drugs and supplements, as some, like blood thinners, may need to be paused before surgery.
Anesthesia options for carpal tunnel surgery include local, regional, or general anesthesia. Local anesthesia numbs only the hand and wrist, allowing the patient to remain awake but pain-free during the procedure. Regional anesthesia, such as a nerve block, numbs a larger area, like the entire arm. General anesthesia, which induces a state of unconsciousness, is an option, though local or regional approaches are often chosen for this outpatient procedure. The choice of anesthesia is made in consultation with the medical team, considering the patient’s health and the surgical approach.
Understanding the Surgical Approaches
The goal of carpal tunnel surgery is to cut the transverse carpal ligament, which forms the roof of the carpal tunnel, to relieve pressure on the median nerve. This division of the ligament creates more space for the nerve and tendons passing through the wrist. The procedure is performed on an outpatient basis and takes between 15 to 30 minutes.
Two main surgical methods are used: open carpal tunnel release and endoscopic carpal tunnel release. In an open carpal tunnel release, the surgeon makes a single incision, about 2 to 3 centimeters long, in the palm of the hand. Through this incision, the surgeon directly visualizes the transverse carpal ligament and divides it. This method allows for a clear view of the anatomical structures within the carpal tunnel.
Endoscopic carpal tunnel release involves smaller incisions, one or two, located in the wrist or palm. A thin tube with a camera, known as an endoscope, is inserted through one of these small cuts, allowing the surgeon to view the inside of the carpal tunnel on a screen. Specialized instruments are then guided through another small incision to cut the transverse carpal ligament. Endoscopic surgery often results in smaller scars and potentially less post-operative pain in the initial weeks compared to the open technique.
Right After the Procedure
Immediately following carpal tunnel surgery, patients are moved to a recovery area for monitoring as the anesthesia wears off. Some discomfort or pain in the hand and wrist is common during this time. Pain management strategies include prescribed oral pain medications to control discomfort. Keeping the hand elevated above the heart using pillows also helps reduce swelling and alleviate pain.
A dressing or splint is applied to the wrist immediately after surgery to protect the surgical site and provide support. This initial bandage is bulky and remains in place for a few days to a couple of weeks. Patients are encouraged to gently move their fingers to prevent stiffness and promote circulation, but strenuous hand use is restricted.
Before discharge, patients receive instructions for at-home care. These instructions cover wound care, managing pain, and recognizing signs of concern such as excessive swelling, redness, or increased drainage from the incision. Since carpal tunnel release is an outpatient procedure, patients can return home the same day. Arranging for someone to provide transportation and assist with daily tasks in the initial recovery period is advisable.
Life After Surgery
Post-operative care involves attention to wound healing and gradual return to activity. Stitches are removed about one to two weeks after surgery. The surgical site may be bandaged, and patients wear a splint or brace for a period to support the wrist and protect the healing tissues. Proper wound care, including keeping the incision clean and dry, prevents infection.
Hand therapy, guided by an occupational or physical therapist, plays a role in recovery. Therapy includes exercises to improve range of motion, increase flexibility, and gradually strengthen the hand and wrist. These exercises, such as wrist bends, finger bends, and tendon gliding, prevent stiffness and promote function. Scar massage may also be recommended to soften the scar tissue and reduce sensitivity.
Activity restrictions are in place during the recovery period for proper healing. Patients are advised to avoid lifting heavy objects or engaging in activities that involve strong gripping or repetitive hand movements for several weeks. The timeline for resuming daily activities, including driving, varies but begins a few weeks after surgery, depending on individual healing and comfort. Full recovery, including the return of strength and sensation, can take several months, with some individuals experiencing continued improvement for up to a year. Minor side effects like tenderness around the incision or occasional “pillar pain” at the base of the palm may occur but resolve over time.