Carpal Tunnel Release

Carpal Tunnel Release

The feeling of tingling, numbness and weakness in the arm due to compression or pressure in the median nerve in the wrist is called carpal tunnel syndrome. The surgery performed for the treatment of carpal tunnel syndrome is called carpal tunnel release. Carpal tunnel is about one inch wide, narrow passage in the wrist. Carpal tunnel syndrome is caused when the carpal tunnel is narrowed down and increases the pressure on the median nerve. The symptoms of carpal tunnel syndrome are most common at night.

The carpel release tunnel release is a safe and effective surgery. The success rate is high and is mainly performed on an outpatient basis. Carpal tunnel release allows more space for the tendon and median nerve to pass, thereby reducing pain and improving functional capacity. It provides relief from the frequently recurring symptoms of pain and debility that are not managed through medications. 

The doctor will suggest you the carpal tunnel release surgery in the following cases: 

1. When other non-surgical treatment methods did not relieve the pain and turned out to be non-effective such as:
   1. Over-the-counter painkiller
   2. Wrist band
   3. Physical therapy
   4. Shorts of corticosteroid medicines
   5. Anti-inflammatory medicines 
   6. Changes in the workplace
   7. Take a break Or Avoid repetitive movements. 
2. The doctor performs electromyography and discovers carpal tunnel syndrome.
3. When the muscle of the hands and wrist are weak and getting smaller because of the pinching of the median nerve
4. When the symptoms last for over six months and get worse.

Endoscopic procedure

The general steps involved in the carpal tunnel release surgery are: 

1. Firstly, the doctor will administer the local anaesthetic to your wrist. It is to numb the hand and the wrist and make the procedure painless. However, you will remain awake during the procedure.
2. The surgeon will make small incisions of about 2-inch on the wrist. One incision is made on the palm and another on the wrist.
3. Then, the surgeon will insert a small tiny camera (called an endoscope) through the incision made. It allows him to see clearly the inside of the wrist on the monitor.
4. Later, the surgeon cuts down the ligament over the carpal tunnel and nearby tissue around the median nerve using the surgical instruments. It helps relieve the pressure from the median nerve and enlarges the carpal tunnel.
5. Once done, all the surgical instruments are removed along with the endoscope. 
6. Finally, the surgeon closes the incisions through sutures or incisions. 
7. The doctor then places the operated hand and wrist in the splint to prevent them from moving. It allows fast recovery. 

Open procedure

1. In this method, the surgeon makes a 2-inch incision from the wrist to the palm. 
2. The surgeon then enlarges the carpal tunnel by cutting the carpal ligament with the help of conventional instruments.
3. The surgeon then places stitches on the incision and covers the wound with a bandage. 
4. The sling is also placed on the wrist to prevent movement. 

Before the carpal tunnel release surgery, you should:

1. Tell your surgeon about all the medicines (including herbs, supplements, and vitamins) you are taking 
2. The doctor will ask you to stop taking blood thinners a week before the surgery, such as aspirin, warfarin
3. Stop drinking and smoking a week before the surgery.
4. The doctor may prescribe the medicines you need to take a day before the surgery.
5. The doctor instructs you to avoid eating and drinking after midnight a day before the surgery.

1. You should reach the hospital at the allotted time. Kindly ask any of your friends or family members to ride you back home after the surgery. 
2. Once you reach the hospital, the staff will ask you to sign some documents for consent. 
3. Then, the nurse will perform some tests to check for vitals. 
4. The nurse will then ask you to remove your clothing and change the hospital gown. 
5. The nurse asks you to remove jewellery (if any) before the surgery. 
6. Once done, you will be shifted to the OT room.

1. It takes on an average of 15 minutes to complete the carpal tunnel release surgery. However, you will remain in the hospital for 2 to 3 hours.
2. Once the surgery is done, the staff will shift you to the recovery room, where the nurses will monitor your vitals for a short time.
3. The doctor discharges you from the hospital on the same day of the surgery.
4. You will be in a heavy bandage and splint for about 1 or 2 weeks.
5. The doctor will prescribe you some antibiotics and painkillers on the day of discharge.
6. The doctor will also ask you to keep the cut clean and dry to avoid infection.

You will have the first appointment with the doctor a week after the surgery. The doctor will check for the recovery and complications. The doctor will remove the bandage or splint on the day of your appointment if everything is fine and healing is good. The doctor will then begin your physical therapy program. The doctor helps in learning motion exercises to improve the hand and wrist movement. You should also avoid heavy lifting for the first few weeks after the surgery. After that, you can continue your daily activities. You can also start with driving and writing after a few days. 

Early treatment is important as permanent nerve, and muscle damage may occur when the signs and symptoms are ignored for a long time.

1. If left untreated for a long time, it can worsen over time. It may lead to irreversible or permanent damage to the hand, like 
   1. Lack of coordination
   2. Weakness
   3. Loss of sensation in the finger and the palm. 
2. In addition, it will start affecting your daily routine and make it hard to perform even any hand-related movements. 
3. To prevent the permanent damage and to provide relief from the symptoms, the doctor may suggest carpal tunnel release surgery as an option to relieve the pressure from the median nerve.

The carpal tunnel release is a safe procedure. However, you should contact the doctor right away if you see any complications after the surgery. Some of the risks associated with the carpal tunnel release surgery are: 

1. Increases pain 
2. Infection at the site of operation 
3. Reaction to the anaesthesia
4. Incomplete release of the ligament leading to surgery failure
5. Injury to the nearby nerve or muscles
6. Scar formation
7. Fever
8. Redness and swelling which persists for more than a week
9. Soreness and weakness in the palm 
10. Bleeding