Carpal Tunnel Release Surgery

The carpal tunnel is a narrow passageway on the palm side of your wrist. Small wrist bones known as carpals 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 carpel tunnel houses the flexor tendons, that allow you to bend your fingers, and the median nerve that provides sensation to most of your fingers and hand.

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.

What are the signs & symptoms of Carpal Tunnel Syndrome?

Some of the common symptoms associated with Carpal Tunnel Syndrome include

• Numbness and tingling in the thumb, index, and middle fingers
• Pain and burning in the hand and wrist that may radiate up the arm to the elbow
• Decreased sensation and weakness in the hand with diminished grip strength
• Worsening of symptoms at night

What are the causes of Carpal Tunnel Syndrome?

The following factors have been known to increase a person’s risk of developing carpal tunnel syndrome:

• Repetitive motion: performing heavy, repetitive hand and wrist movements with prolonged gripping at work or play
• Congenital: Some people are born with narrower carpal tunnel canals.
• Trauma: Injury to the wrist such as fractures or sprains.
• Hormonal changes: Pregnancy, menopause, birth control pills or hormone pills are risk factors as they alter the levels of hormone in the body.
• Medical conditions:  Conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumor extending to the carpal tunnel

How is Carpal Tunnel Syndrome diagnosed?

Your doctor diagnoses carpel tunnel syndrome by reviewing your detailed medical history and a physical examination. Further tests may be ordered including an X-ray to view your wrist bones; blood tests to rule out underlying medical conditions such as diabetes, arthritis and thyroid problems, and electro diagnostic testing to assess the speed and degree of electrical activity in your nerves and muscles.

What are the treatment options?

Carpel tunnel syndrome 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.

How is the surgical procedure performed?

In endoscopic surgery, a thin, flexible tube with a camera (endoscope) attached to its end is employed. Our technique that we perform utilizes a single portal (incision) placed at the wrist above the palm 1 cm in length. 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 our single-portal technique, a small tube contains both the camera and the cutting tool. After insertion of the camera and cutting tool, the transverse carpal ligament is transected (cut). This releases the pressure on the median nerve and alleviates the symptoms of carpal tunnel syndrome.

The small incision is closed with stitches.

What are the steps taken for post-operative care?

Patient having carpal tunnel release surgery can be discharged the same day.
Your surgeon will suggest certain post-operative procedures for a better recovery and to avoid complications.

• Elevate the hand above heart level to reduce swelling
• A splint may be worn but is not necessary
• Ice packs to the surgical area to reduce swelling
• The postoperative dressing may be removed after 3-4 days, and the patient may shower normally
• Physical therapy is rarely necessary to restore wrist strength with this minimally invasive technique
• Eating a healthy diet and not smoking will promote healing

The 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.