Carpal Tunnel Syndrome
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Key Points: Carpal Tunnel Release Surgery
Type of Anaesthetic: Local Length of Procedure: Around 30 minutes Nights in Hospital: 0-1 nights Recovery: Time off Work: 0-2 weeks Back to Normal: around 4 weeks |
Carpal tunnel syndrome is a hand and arm condition that causes numbness, tingling and other symptoms. Carpal tunnel syndrome is caused by a pinched nerve in your wrist.
Bound by bones and ligaments, the carpal tunnel is a narrow passageway located on the palm side of your wrist. This tunnel protects a main nerve to your hand and the nine tendons that bend your fingers. Compression of the nerve produces the numbness, tingling in the thumb, index, middle and ring finger. You may get disturbed sleep if it becomes painful and, eventually, hand weakness leading to dropping objects. Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the tingling and numbness and restore wrist and hand function. Tests and diagnosis X-ray: You may get an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture. Electromyogram: Electromyography measures the tiny electrical discharges produced in muscles. During this test, a thin-needle electrode is inserted into specific muscles. The test evaluates the electrical activity of your muscles when they contract and when they're at rest. This test can determine if muscle damage has occurred and also may be used to rule out other conditions. Nerve conduction study. In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose your condition and rule out other conditions. Amir Tadros may recommend that you see a doctor trained in brain and nervous system conditions (neurologist), brain and nervous system surgery (neurosurgeon), hand surgery, rheumatoid arthritis, or other areas if your signs or symptoms indicate other medical disorders or need additional treatment. Treatment Nonsurgical therapy: If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome. Methods may include: Wrist splinting. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Nocturnal splinting may be a good option if you're pregnant and have carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen may help relieve pain from carpal tunnel syndrome in the short term. There isn't evidence, however, that these drugs improve carpal tunnel syndrome. Corticosteroids: Your doctor may inject your carpal tunnel with a corticosteroid such as cortisone to relieve your pain. Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren't considered as effective as corticosteroid injections for treating carpal tunnel syndrome. If carpal tunnel syndrome results from an inflammatory arthritis, such as rheumatoid arthritis, then treating the arthritis may reduce symptoms of carpal tunnel syndrome, but this hasn't been proved. Surgery If your symptoms are severe or persist after trying nonsurgical therapy, surgery may be the most appropriate option. The goal of carpal tunnel surgery is to relieve pressure on your median nerve by cutting the ligament pressing on the nerve. The surgery may be performed with two different techniques. Discuss the risks and benefits of each technique with your surgeon before surgery. Surgery risks may include incomplete release of the ligament, wound infections, scar formation, and nerve or vascular injuries. The final results of endoscopic and open surgery are similar. Endoscopic surgery: In endoscopic surgery, your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel and cut the ligament through one or two small incisions in your hand or wrist. Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery. Open surgery: In open surgery, your surgeon makes a larger incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve. This procedure may also be conducted using a smaller incision, which may reduce the risk of complications. During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve than existed before. Incisions The incisions are usually along the palm. Scars These scars tend to heal very well but are prone to some stretching over time. They will initially appear a little pink in the first few weeks, but will then fade to white. Most patients will form extremely good quality scars over time. The length of time will vary in each individual patient. However it is important to start massaging early in order to avoid thickened scar. Medicines A full medical history will be obtained before any surgery. As a precaution, do not take any over the counter medicines or herbal remedies prior to surgery or for 3 days following. Also avoid aspirin, ibuprofen and Voltarol based tablets. It would be useful to bring a list of any prescribed medications to your pre-op assessment. Smoking If you are a smoker, try and stop for six weeks before and after surgery as it can reduce the chances of complications. Recovering from Carpal Tunnel Surgery Length Of Surgery : The Operation is usually carried out under local anaesthetic and takes about 30 minutes. Length Of Stay In Hospital: Usually a day case operation which means you’ll be home the same day. Dressings And Stitches : your hand will be dressed to keep your fingers straight and to reduce pain after the operation. This dressing is usually worn for 5 days after which the dressings are changed. The sutures are usually removed after about 14 days by which time all wounds are usually healed. Hand therapy exercises are then initiated. Post-Operative Instructions And Recovery Day 1: You should be taking it very easy! Relaxing with your hand elevated at home and on a few pillows when asleep. Day 2-5: You can be up and about but you may be in some discomfort so avoid using your hand Day 5-14: Most of the swelling and bruising will settle over this next week. You will be feeling much better from here onwards. You can start hand exercises gently and build it up over the next 10 days. Week 4 onwards: you will be nearly back to normal. Time Off Work And Socialising: People vary in recovery and this will depend on the size of area treated, but allow 10-14 days. Full anaesthetic can take longer to recover from. Most patients are very comfortable at one week and feel more stiff than in pain. Time To Exercise: Patients usually feel able to exercise the fingers gently after 14 days. Strenuous exercise (aerobics etc) should be avoided for 3 weeks, and contact sports for 6 weeks. Driving Patients should avoid driving until they are completely free of pain and restriction, and be able to confidently perform an emergency stop. This is to ensure they will be covered by their insurance policy. It may take up to two or three weeks to recover sufficiently. Follow Up We will check your wound at day 5 and again the following week. You will then have an appointment with Amir Tadros at 3 months. Final Outcome Although most of your result will be noticeable immediately it will continue to improve over the first three months. Potential Complications With Carpal Tunnel Release Surgery This is a routine operation that is a great success for the vast majority of patients. However, as with any procedure, it is very important you understand what can go wrong as well as right. The potential complications are listed below: Wound healing problems: Occasionally, the wounds don’t heal within 14 days and the dressings may continue for a longer period depending on the wound Scars: The quality of scars vary between patients as they may stretch differently. Skin irregularity: Small areas of irregularity and skin thickening can be observed. Softening of the scar: The tightening will soften over the first 6 months with the scar falling slightly. Altered sensation: Some altered sensation can be noticed but usually settles over the first few weeks. Bruising/bleeding: Usually minor but can be greater occasionally. General operation risks: Chest infections, Blood clots in the leg or lung (DVT or PE). Although rare it is important to avoid these by not smoking, being excessively overweight and moving about after surgery as soon as possible. In general, you will be encouraged to use your hand after surgery, gradually working back to normal use of your hand while avoiding forceful hand motions or extreme wrist positions. Soreness or weakness may take from several weeks to a few months to resolve after surgery. If your symptoms were very severe before surgery, symptoms may not go away completely after surgery. Prevention There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on your hands and wrists by taking the following precautions: Reduce your force and relax your grip. Most people use more force than needed to perform many manual tasks. If your work involves a cash register, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink. This way you won't have to grip the pen tightly or press as hard on the paper. Take frequent breaks. Give your hands and wrists a break by gently stretching and bending them periodically. Alternate tasks when possible. If you use equipment that vibrates or that requires you to exert a great amount of force, taking breaks is even more important. Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. If you use a keyboard, keep it at elbow height or slightly lower. Improve your posture. Incorrect posture can cause your shoulders to roll forward. When your shoulders are in this position, your neck and shoulder muscles are shortened, compressing nerves in your neck. This can affect your wrists, fingers and hands. Keep your hands warm. You're more likely to develop hand pain and stiffness if you work in a cold environment. If you can't control the temperature at work, put on fingerless gloves that keep your hands and wrists warm. |
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