Carpal tunnel release

Carpal tunnel release

Definition

Carpal tunnel syndrome can be caused by pressure on the median nerve at the wrist, which can lead to pain and weakness in the hand. The median nerve supplies feelings to the thumb, first two fingers, part of the third finger, and also to some of the muscles of the hand.

Indications

Patients who have symptoms consistent with carpal tunnel syndrome usually undergo non-surgical treatment first. This includes anti-inflammatory medications, wrist splints, occupational therapy, and workplace modification. If this fails to improve symptoms, an injection of steroids into the carpal tunnel may be helpful.

If all treatments do not help, most surgeons will use an EMG to test the electrical activity of the median nerve. If the results of the test are consistent with carpal tunnel syndrome, carpal tunnel release surgery is an option.

Convalescence

This surgery is usually done on an outpatient basis. Complete recovery can take anywhere from several weeks to a year, depending on the severity of damage to the nerve.

A splint may be used to reduce wrist motion for the first few days after surgery, but motion should not be delayed for too long because the wrist can become stiff.

The longer the symptoms lasted before surgery, and the more severely damaged the nerve appears at surgery, the longer the recovery time.

Expectations after surgery

Carpal tunnel release is successful in improving strength and decreasing pain in about 85% of patients, if these patients are a good fit for the surgery. The procedure resolves pain, nerve tingling, and numbness more reliably than it resolves muscle weakness. Unfortunately, the longer the symptoms have been present, the longer the recovery time and the more variable the extent of recovery.

Risks

Risks for any anesthesia include the following:

• Allergic reactions to medications
• Problems breathing

• Bleeding
• Infection

Risks specific to carpal tunnel release include the following:

• Injury to the median nerve or its branches
• Failure of the surgery to improve symptoms
• Rarely, injury to another nerve or blood vessel (artery or vein)
• Scar sensitivity

Carpal tunnel syndrome

Surface anatomy - normal palm

Surface anatomy - normal wrist

Wrist anatomy

Carpal tunnel repair - series

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