Carpal
tunnel release:
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Carpal
tunnel syndrome can be
caused by compression of the median
nerve at the wrist, which can
lead to pain and weakness in the
hand. The median nerve supplies
sensation to the thumb, first
two fingers, part of the third
finger, and also to some of the
muscles of the hand.
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Overview
& Description
The carpal tunnel
is composed of two "walls" --
the deep wall is the bones of the wrist
and the superficial wall is a thick ligament
located just under the skin on the palm
side of the wrist. The median nerve and
the tendons that flex the fingers to form
a fist pass through this tunnel. Certain
conditions such as wrist fractures, inflammatory
conditions (rheumatoid arthritis, for
example) and overuse syndromes can cause
swelling in the carpal tunnel. Sometimes
there is no identifiable cause. Because
the walls of the tunnel are rigid, the
swelling increases pressure.
Nerves are very
sensitive to pressure, and when the median
nerve is compressed, the muscles it supplies
become weak and the skin over the thumb,
index, and middle fingers becomes painful,
tingly, or even numb.Carpal tunnel surgery
involves 1 or 2 small incisions over the
palm of the hand. The surgery can be performed
endoscopically (using a small camera attached
to a monitor). The carpal ligament is
directly below the incision(s), in the
area of the palm just past the wrist on
the palm in the direction of the fingers
(distal). This ligament is cut longitudinally
(in line with the arm). This releases
the pressure on the nerve passing through.
Some surgeons will
remove tissue surrounding the nerve, especially
if the tissue is swollen or irritated
(as is often found in arthritis patients).
The surgeon will then usually close the
skin and subcutaneous tissues over only
the carpal ligament, leaving the carpal
tunnel uncovered. Other surgeons reattach
the carpal ligament after lengthening
it.
After the surgery,
the wrist is usually immobilized in a
splint or heavy bandage for about a week.
Then motion exercises or a physiotherapy
program will begin.
Carpal
Tunnel Release: Expectations after Surgery
Carpal tunnel release
is successful in improving strength and
decreasing pain in about 85% of properly
selected patients. It more reliably resolves
pain and nerve tingling/numbness than
muscle weakness. Unfortunately, the longer
the symptoms have been present, the longer
the recovery time and the more variable
the extent of recovery.
Carpal
Tunnel Release: Convalescence & Recovery
This surgery is
usually done on an outpatient basis. Complete
recovery can take anywhere from several
weeks to a year, depending on the severity
of damage to the nerve.A splint may be
used to reduce wrist motion for the first
few days after surgery, but motion should
not be delayed for too long because the
wrist can become stiff.
The longer the
symptoms lasted before surgery and the
more severely damaged the nerve appears
at surgery, the longer the recovery time.
Carpal
Tunnel Release: Risks
Risks for any
anesthesia include the following:
