Carpal tunnel release

Answer 1

Definition

Carpal tunnel release is surgery to treat carpal tunnel syndrome. Carpal tunnel syndrome is pain and weakness in the hand that is caused by pressure on the median nerve in the wrist.

Description

The median nerve and the tendons that flex (or curl) your fingers go through a passage called the carpal tunnel in your wrist. This tunnel is narrow, so any swelling can pinch the nerve and cause pain. A thick ligament (tissue) just under your skin makes up the top of this tunnel.

First, you will receive anesthesia (numbing medicine) so that you will not feel pain during surgery. You will be awake but also receive medicines to make you relax.

In carpal tunnel release, the surgeon will cut through this ligament to make more space for the nerve and tendons.

• First your surgeon will make a small incision (cut) in the palm of your hand near your wrist.
• Then your surgeon will cut the carpal transverse ligament to ease the pressure on the median nerve. Sometimes, tissue around the nerve is removed as well.
• Your surgeon will then close the skin and tissue underneath with sutures (stitches).

Sometimes surgeons do this procedure using a tiny camera that is attached to a monitor. The surgeon inserts the camera into your wrist through a very small incision and looks at the monitor to see inside your wrist. This is called endoscopic surgery. The instrument used is called an endoscope.

Why the Procedure Is Performed

Patients with symptoms of carpal tunnel syndrome usually try non-surgical treatments first. These are:

• Anti-inflammatory medicines
• Occupational therapy
• Workplace changes to improve your seating and how you use equipment at work
• Wrist splints
• Shots of corticosteroid medicine into the carpal tunnel

If none of these treatments help, some surgeons will test the electrical activity of the median nerve with an EMG. If the test shows that the problem is carpal tunnel syndrome, carpal tunnel release surgery may be recommended.

If the muscles in the hand and wrist are getting smaller because the nerve is being pinched, surgery will usually be done right away.

Risks

Risks of carpal tunnel release are:

• Allergic reactions to medicines
• Bleeding
• Infection
• Injury to the median nerve or nerves that branch off of it
• Rarely, injury to another nerve or blood vessel (artery or vein)
• Scar sensitivity

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

• You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen, (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help. Smoking can slow healing.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Your doctor or nurse will tell you when to arrive at the doctor's office.

After the Procedure

This surgery is done on an outpatient basis. You will not need to stay in the hospital.

After the surgery, your wrist will probably be in a splint or heavy bandage for about a week. After the splint or bandage is removed, you will begin motion exercises or a physical therapy program.

Outlook (Prognosis)

Carpal tunnel release decreases pain, nerve tingling, and numbness better, and restores muscle strength. Still, most people are helped by this surgery.

The length of your recovery will depend on how long you had symptoms before surgery and how badly damaged your median nerve is. If you had symptoms for a long time, you may not be completely free of symptoms after you recover.

References

Wright PE II. Carpal tunnel, ulnar tunnel, and stenosing tenosynovitis. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 73.

Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomized parallel-group trial. Lancet. 2009;374(9695):1074-1081.

Keith MW. American Academy of Orthopaedic Surgeons clinical practice guidelines on the treatment of carpal tunnel syndrome. J Bone Joint Surg Am. 2009;91(1):218-219.

Cellocco P, Rossi C, Boustany SE, di Tanna GL, Costanzo G. Minimally invasive carpal tunnel release. Orhtop Clin North Am. 2009;40(4):441-448.

Answer 2

Definition

Carpal tunnel release is surgery to treat carpal tunnel syndrome. Carpal tunnel syndrome is pain and weakness in the hand that is caused by pressure on the median nerve in the wrist.

Description

The median nerve and the tendons that flex (or curl) your fingers go through a passage called the carpal tunnel in your wrist. This tunnel is narrow, so any swelling can pinch the nerve and cause pain. A thick ligament (tissue) just under your skin makes up the top of this tunnel.

First, you will receive anesthesia (numbing medicine) so that you will not feel pain during surgery. You will be awake but also receive medicines to make you relax.

In carpal tunnel release, the surgeon will cut through this ligament to make more space for the nerve and tendons.

• First your surgeon will make a small incision (cut) in the palm of your hand near your wrist.
• Then your surgeon will cut the carpal transverse ligament to ease the pressure on the median nerve. Sometimes, tissue around the nerve is removed as well.
• Your surgeon will then close the skin and tissue underneath with sutures (stitches).

Sometimes surgeons do this procedure using a tiny camera that is attached to a monitor. The surgeon inserts the camera into your wrist through a very small incision and looks at the monitor to see inside your wrist. This is called endoscopic surgery. The instrument used is called an endoscope.

Why the Procedure Is Performed

Patients with symptoms of carpal tunnel syndrome usually try non-surgical treatments first. These are:

• Anti-inflammatory medicines
• Occupational therapy
• Workplace changes to improve your seating and how you use equipment at work
• Wrist splints
• Shots of corticosteroid medicine into the carpal tunnel

If none of these treatments help, some surgeons will test the electrical activity of the median nerve with an EMG. If the test shows that the problem is carpal tunnel syndrome, carpal tunnel release surgery may be recommended.

If the muscles in the hand and wrist are getting smaller because the nerve is being pinched, surgery will usually be done right away.

Risks

Risks of carpal tunnel release are:

• Allergic reactions to medicines
• Bleeding
• Infection
• Injury to the median nerve or nerves that branch off of it
• Rarely, injury to another nerve or blood vessel (artery or vein)
• Scar sensitivity

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

• You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen, (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help. Smoking can slow healing.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Your doctor or nurse will tell you when to arrive at the doctor's office.

After the Procedure

This surgery is done on an outpatient basis. You will not need to stay in the hospital.

After the surgery, your wrist will probably be in a splint or heavy bandage for about a week. After the splint or bandage is removed, you will begin motion exercises or a physical therapy program.

Outlook (Prognosis)

Carpal tunnel release decreases pain, nerve tingling, and numbness better, and restores muscle strength. Still, most people are helped by this surgery.

The length of your recovery will depend on how long you had symptoms before surgery and how badly damaged your median nerve is. If you had symptoms for a long time, you may not be completely free of symptoms after you recover.

References

Wright PE II. Carpal tunnel, ulnar tunnel, and stenosing tenosynovitis. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 73.

Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomized parallel-group trial. Lancet. 2009;374(9695):1074-1081.

Keith MW. American Academy of Orthopaedic Surgeons clinical practice guidelines on the treatment of carpal tunnel syndrome. J Bone Joint Surg Am. 2009;91(1):218-219.

Cellocco P, Rossi C, Boustany SE, di Tanna GL, Costanzo G. Minimally invasive carpal tunnel release. Orhtop Clin North Am. 2009;40(4):441-448.

Reviewed By

Review Date: 05/25/2010

A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery (2/3/2009).