We know through experience that the decision to undergo carpal tunnel release is generally preceded by a long decision making process. With this information we would like to help you with this process, by advising you about the procedure itself and the possibilities and risks involved with this operation. This advice, does not however, replace the need for an extensive personal consultation with your surgeon who will thoroughly address your specific questions.
When is a carpal tunnel release necessary?
What is the aim of carpal tunnel release?
What do I have to consider before a carpal tunnel release (pre-operative phase)?
What do I have to consider after a carpal tunnel release (post-operative phase)?
What are the possible risks with a carpal tunnel release?
Which result can I expect after a carpal tunnel release and what are the chances of success?
In the wrist, the metacarpal bones form the base of relatively narrow channel, through which, run the tendons, blood vessels and nerves. This channel is tightly bound towards the palm by band of tough connective tissue and it is through an increase of volume within this channel, often caused by injuries or tumours, and in most cases by simple swelling of the tissue; that pressure is placed on the channel structures running through it. The nervous tissue, in this case the median nerve, is very sensitive to increased pressure and it is this pressure that can cause abnormalities in nerve conduction. Symptoms are numbness in the first to third fingers and pain in the hand that may radiate to the forearm and cause a possible weakness of the muscle at the base the thumb.
The aim of the procedure is to sever the tight wrist band (transverse carpal ligament) and thus eliminate the restriction of the nerve.
Procedure. Carpal tunnel release can be performed either endoscopically or by an open technique. With the endoscopic procedure, a small incision, approximately 1cm, is made in the wrist area, and a second incision is made in the palm. Through these incisions the tight wrist band is cut under endoscopic control. With the open technique, the incision is made along the lifeline of the palm and slightly extended over the wrist, where the wrist band is exposed and cut. The nerve can then be inspected, and if required, freed from the connective tissues.
Type of anaesthesia. The surgery is usually performed under general anaesthetic or plexus anaesthetic and in some cases can be performed under local anaesthetic.
There is no special preparation needed. Information on general measures and the necessary preliminary examinations will be put together for you personally in a pamphlet which you will receive at your consultation.
The drain is removed 2 days after surgery and the stitches after 12 to 14 days. Until the stitches have been removed a dressing has to be worn at all times. Immediately after the operation it is important not to let the hand hang down as this can result in swelling. At night it is advisable to rest the hand on a cushion or pillow. Tight gripping or lifting of heavy objects should be avoided whereas the moving of the fingers without applying any strain is possible and can aid recovery.
No procedure is without risk. The general risks of surgery include the possibility of bleeding, thrombosis and infection. Specifically with carpal tunnel release, especially where there has been a long-term existing narrowing of the nerve, a full and complete relief of the symptoms may not be achieved.
Pain relief. When caught early, a full recovery from the symptoms is achieved. In long term cases, residual symptoms may still remain after surgery, although a significant reduction is achieved.