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Carpal tunnel syndrome - Orthopaedics SA

Carpal Tunnel Release

Carpal tunnel release is a surgery performed to treat carpal tunnel syndrome. It aims to relieve symptoms by decreasing pressure on the median nerve.

The median nerve provides nerve signals to the thumb and sensation to the palm side of the thumb and some fingers. If the passage housing the nerve becomes inflamed due to illness, injury, or scarring, it may result in pain and numbness in the hand.

Carpal tunnel release surgery is usually performed under a local anaesthetic. It can be carried out as an open procedure (through a small 2cm incision in the front of the wrist) or using an endoscopic (key-hole) approach (through a single (or double) 1cm incision(s) in the distal forearm +/- palm).

The surgeon cuts the transverse carpal ligament, which is a ligament in the wrist making up the roof of the carpal tunnel (the space housing the median nerve). This increases the amount of space available for the nerve and reduces pressure on the nerve.

As the transverse carpal ligament is not believed to serve any functional purpose, cutting it in the surgery does not lead to a change in wrist function or complications.

The benefits of carpal tunnel release surgery include a reduction in symptoms of carpal tunnel syndrome. These include relief from pain and numbness as well as increased grip strength and improved ability to do some everyday tasks (such as opening jars).

All surgical procedures include risks of scarring, bleeding and infection. Specific risks related to carpal tunnel release surgery include:

·      Incomplete relief of carpal tunnel symptoms

·      Pain and stiffness in the hand

·      Median nerve damage (leading to numbness in the thumb and first two fingers which is extremely rare)

·      A sensitive scar following healing

Patients may be deemed suitable for carpal tunnel release surgery if their symptoms are persistent and they have attempted non-surgical therapies with little or no success.

Patients with deformities in the wrist – such as tumours, ganglions, arthritis or scarring – may need to be treated with an open surgical approach instead of an endoscopic (key-hole) one. This is because the cause of the carpal tunnel syndrome cannot be adequately addressed with an endoscopic approach.

Overall, suitability for carpal tunnel release is determined on an individual basis. Your Orthopaedics SA surgeon will conduct a full assessment and determine whether surgery is right for you before making any recommendations.

Recovering form carpal tunnel surgery takes up to 12 weeks in most cases, although this can vary significantly by each person. Your orthopaedic surgeon will give you an individualised estimate on your recovery time.

Most patients can leave the hospital on the same day as the procedure. You may need to keep your hand elevated to minimise swelling and ice your hand in some circumstances.

Driving can generally be resumed 1-2 weeks post-procedure under your surgeon’s guidance. Other light activities – such as desk work – can be started as soon as pain permits. Be mindful to avoid repetitive movements, which may unduly stress the wrist during recovery.

Many patients experience a dramatic reduction in their carpal tunnel symptoms almost immediately. Pain from pressure on the median nerve is decreased and grip strength increases, although it takes up to 6 months to reach full strength. A physiotherapy program can help restore strength and motion for optimal recovery.