About Carpal Tunnel Surgery

By Health & Medical Last updated Wednesday, May/15/2024

Identification

The carpal tunnel is the passageway through the ligaments and bones of the wrist through which the median nerve enters the hand. When the passageway is narrowed through illness or repetitive stress the transverse carpal ligament, which forms the top of the passageway on the palm side of the wrist, compresses the nerve. This will cause the muscles controlled by that nerve to weaken. It also interrupts the nerve's ability to transmit sensory information, so the palm, fingers and thumb may tingle or become numb. If this condition persists it is called Carpal Tunnel Syndrome.

When patients first discuss their condition with their doctors carpal tunnel surgery is usually not the first course of treatment. Medication such as muscle relaxers can help loosen the tight muscles and ligaments putting pressure on the median nerve. If strain or injury has caused swelling in the wrist that could also aggravate the symptoms of carpal tunnel syndrome, and an anti-inflammatory may relieve the pressure. Pain relievers alone may be enough to allow normal usage of the hands in minor cases. Massage therapy is effective for some patients by releasing the tight muscles and ligaments.

There are two ways to perform this surgery. Open carpal tunnel surgery involves making an incision in the base of the palm down the wrist. The skin is retracted to allow access to the carpal tunnel area. The doctor snips completely through the transverse carpal ligament, releasing the trapped nerve. The ends of the ligament are left apart. Scar tissue will eventually fill the gap as the wrist heals. The skin is then closed.
The other way the surgery can be performed is endoscopically. A small incision is cut into the lower palm. If the cutting tool and camera are attached this is the only incision needed. If the tools are separate then another incision will be made in the wrist for the camera. Like in the open carpal tunnel syndrome the transverse carpal ligament is snipped completely through. The incision is smaller in the endoscopic carpal tunnel surgery, resulting in shorter healing time for the incisions and a much smaller scar.

Carpal tunnel surgery is an outpatient surgery. Usually only a local anesthetic is given to numb the area during the operation. Stitches will close the incisions that will be located on the palm and inside of the wrist and are removed two weeks after surgery. Less than 5% of patients experience complications after surgery, primarily as a result of post operative infection or nerve damage is the median nerve is accidentally nicked during surgery.

The wrist is wrapped with a bandage and immobilized with a splint for several weeks after surgery. For the dominant hand the wrist will require a few weeks of rest before rehabilitation can begin. It can take up to three months for the dominant hand to be back up to full strength. The non dominant hand usually requires less recovery and rehabilitation. Patients with surgery on the non dominant hand can return to work with light duty after a few days, and can return to normal activity levels in two weeks.

There are alternatives to carpal tunnel surgery for patients who want to avoid surgery. Chiropractors treat carpal tunnel with upper cervical manipulations, with the idea that the spinal bones in the neck are compression the nerves that eventually lead down to the hands, causing the symptoms of weakness and pain. Acupuncture and acupressure also can be used to try and relieve the tightness of the wrist ligament and to relieve pain without medication. A study in Japan suggested that a deficiency of vitamin B6 is associated with the symptoms of carpal tunnel syndrome.