Are You Considering
Carpal Tunnel Surgery?

Carpal tunnel surgery is frequently recommended for significant carpal tunnel syndrome. Is surgery necessary? What should you know about this surgery and recovery? Get all the answers before you undergo surgery for this hand joint pain condition.





What Is The Carpal Tunnel?

The carpal tunnel is, as it sounds, a tunnel formed by a row of bones and a ligament at the base of the hand. This tunnel is created by carpal bones below and the transverse ligament above. It is through this tunnel that various tendons and the median nerve travel through in order to allow for movement and sensation in the hand and fingers.


What Is Involved With Carpal Tunnel Surgery?

Carpal tunnel syndrome involves the median nerve becoming pinched within the carpal tunnel. Pinching of this nerve causes symptoms of weakness, numbness, and pain in the thumb and first two fingers.

Surgery for carpal tunnel, often called a carpal tunnel release, involves releasing the median nerve from being pinched. This is accomplished by cutting the transverse ligament that helps to form the tunnel, thus decompressing the median nerve and relieving the hand joint pain.

The surgical procedure itself has been improved over the last number of years. In the past an open procedure was the most common procedure. With the open procedure a large incision was cut in order to release the ligament. Because of the size of the incision; swelling, pain, and limited soft tissue mobility often resulted in longer recovery times.

carpal tunnel surgery


More recently the endoscopic procedure has become increasingly common. With this procedure, generally two small incisions are made instead of one large one. The incisions allow a small camera to be inserted allowing the surgeon to view the carpal ligament as the ligament is cut. These smaller incisions result in less swelling, pain, and scaring compared to the open procedure.

Although recovery is generally a bit faster with the endoscopic approach, there are some studies that indicate the risk of damaging the median nerve is slightly higher with the endoscopic approach. However, to date, there are no definitive studies that conclusively that the endoscopic approach has a better overall outcome than the standard open procedure.


endoscopic carpal tunnel surgery


With either procedure, the surgery is done on an outpatient basis. Use of the hand generally can begin within a few days of surgery.

The success rate of carpal tunnel release surgery is quite high, from 70%-90%. Recovery time is influenced by the length of time symptoms were present prior to surgery. A lack of success is most commonly associated with an incorrect diagnosis. Because neurological symptoms in the hand can be related to other sources (cervical spine and elbow), having an accurate diagnosis is primary for a positive outcome.


Who Should Have Carpal Tunnel Release?

For carpal tunnel symptoms that are mild to moderate, generally conservative treatment is effective. Conservative treatment includes anti-inflammatory medication, cortisone injections, B-6 supplementation, wrist splinting, physical therapy, and activity modification.

In cases when severe median nerve injury has occurred surgery may be warranted prior to attempting conservative treatment. A nerve conduction test will indicate the extent of median nerve damage or involvement. In addition, when conservative has not been effective in reducing symptoms, carpal tunnel surgery is a reasonable choice.



What To Expect Following Carpal Tunnel Surgery

Following carpal tunnel surgery the wrist and hand will be wrapped in a bandage and activity will be limited for a few days. Stitches are generally removed within 10 days following surgery. A soft cast or brace may be used in the early stages of healing. Physical therapy is generally initiated within the first two weeks following surgery.


Bandage following carpal tunnel surgery


The ability to return to work activity will be based on both the type of work you do and whether the surgery was performed on your dominant hand. Recovery can take from a few weeks to a few months depending on which procedure was performed, the activity you plan to return to, the severity of the symptoms prior to surgery, and whether surgery was performed on your dominant hand.


Physical Therapy

Following carpal tunnel surgery, physical therapy is often recommended. Physical therapy will generally last between six and eight weeks following surgery with full recovery taking up to three months.

As with any surgical procedure, swelling should be minimized with the use of ice therapy and elevation of the hand above the level of the heart. Swelling will increase pain and reduce range of motion thus every effort should be made to reduce postoperative swelling.

In order to improve flexibility, the therapist will do soft tissue mobilization to the incision and surrounding tissues. To help minimize scaring, massage Vitamin E over the healed incision.

In the early stages of rehabilitation the goal will be to restore normal range of motion of the wrist and hand. At first the physical therapist will manually stretch and move the hand and wrist. Additional stretching exercises will be added including stretches for you to do at home.

As mobility improves light strengthening exercises will be incorporated. Gripping activities will often involve various exercises using putty.

hand putty exercise

Finally, after range of motion and strength have improved, activities to address dexterity will also be utilized. If the surgery was performed on your dominant hand, more focus will be direct to restoring dexterity.

Carpal tunnel surgery can be a very effective procedure. As with any surgery, get more than one opinion and take advantage of conservative treatment options. Ask your surgeon specific questions about the procedure being used, length of recovery expected, and how many procedures of this nature the surgeon has performed. Doing your homework before undergoing the procedure will improve your chances of a successful outcome.




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References

Arthritis Rheum. 2001 May;44(5):1184-93.Predictors of outcomes of carpal tunnel release.Katz JN, Losina E, Amick BC 3rd, Fossel AH, Bessette L, Keller RB.

Arch Phys Med Rehabil. 2010 Jul;91(7):1005-24.Carpal tunnel syndrome. Part II: effectiveness of surgical treatments--a systematic review.Huisstede BM, Randsdorp MS, Coert JH, Glerum S, van Middelkoop M, Koes BW.

Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003905.Surgical treatment options for carpal tunnel syndrome.Scholten RJ, Mink van der Molen A, Uitdehaag BM, Bouter LM, de Vet HC.