Carpal Tunnel Release
The carpal tunnel is a narrow passageway on the palm side of your wrist. Small wrist bones known as carpal form the bottom and sides of your carpal tunnel and a strong band of connecting tissue, known as the transverse carpal ligament, covers the top of the carpal tunnel.
The carpal tunnel houses the flexor tendons, that allow you to bend your fingers, and the median nerve, which provides sensation to most of your fingers and hand.
Disease Overview
Special tissues known as synovium surround and lubricate the flexor tendons in your wrist, allowing smooth movement of the fingers. Carpal Tunnel Syndrome occurs when the synovium swells, narrowing the limited space within the tunnel and pinches the median nerve over time. The transverse carpal ligament can also become tight, narrowing the carpal tunnel space and putting pressure on the median nerve.
Treatment Options
Carpal tunnel can be treated with conservative measures or surgical intervention. Conservative treatment options may include treating any underlying medical conditions, such as diabetes and arthritis. Your hand and wrist may be immobilized with a splint or wrist brace for 4 to 6 weeks. Ice packs may be recommended to keep down any swelling. You may be advised to avoid activities that tend to bring on the symptoms. Medication and steroid injections may be used to treat pain and swelling. You may be referred to therapy to be taught strengthening and stretching exercises.
When conservative treatment options are not effective, surgery may be recommended.
Carpal Tunnel Release Surgery
Carpal Tunnel Release surgery may be performed using a thin, flexible tube with a camera (endoscope) attached to its end. In a single-portal technique, a small incision is made in the wrist while in a two-portal technique, two incisions are made, one each at the wrist and palm. The endoscope is inserted through the small incision and helps the doctor visualize the internal structures at the wrist such as the transverse carpal ligament, avoiding the need for a large incision.
When the ligament is located, a tiny cutting tool is employed to release the ligament. In the single-portal technique, a single small tube contains both the camera and the cutting tool; whereas, in the two-portal technique, the camera and cutting tool are inserted through different incisions. After insertion of the cutting tools through the respective incisions, the transverse carpal ligament is cut. This releases the pressure on the median nerve and alleviates the symptoms of carpal tunnel syndrome.
The small incisions are closed with stitches. The ligament will heal with the development of scar tissue around the cut ends.
What are the Steps taken for Postoperative Care?
Patient having carpal tunnel release surgery can be discharged the same day.
Your surgeon will suggest certain postoperative procedures for a better recovery and to avoid complications.
- Elevate the hand above heart level to reduce swelling.
- A splint may be worn.
- Apply ice packs to the surgical area to reduce swelling.
- Keep the surgical incision clean and dry. Cover the area with a plastic wrap when bathing or showering.
- Physical therapy may be ordered to restore wrist strength.
- Eat a healthy diet and do not smoke to promote healing.
Majority of patients do not suffer any complications following carpal tunnel release surgery, but as with any surgery, complications can occur and can include continued pain, infections, scarring and nerve damage, causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.