Carpal Tunnel Release

What is Carpal Tunnel Release?

Carpal Tunnel Release is a surgical procedure that is performed to relieve the symptoms of carpal tunnel syndrome. 

Carpal tunnel syndrome is characterised by numbness, tingling, weakness, or pain in the hands due to pressure on the median nerve in the wrist. This nerve travels through a narrow pathway called the carpal tunnel, and when this pathway becomes inflamed or swollen, it can put pressure on the nerve causing the symptoms. 

The release procedure involves cutting the ligament that forms the carpal tunnel's top, relieving the pressure on the median nerve and alleviating symptoms.

Who is Suitable for Carpal Tunnel Release?

Carpal Tunnel Release is suitable for people with severe or persistent carpal tunnel syndrome symptoms that have not responded to more conservative treatments like wrist splinting, medication, or physical therapy. It may also be recommended for individuals with muscle weakness or damage that can't be reversed, as determined by a physical examination or electromyography (EMG) testing.

Benefits of Carpal Tunnel Release

Carpal Tunnel Release can significantly reduce the pain, numbness, and tingling associated with carpal tunnel syndrome. It can also help restore muscle strength and normal function in the hand and fingers if carpal tunnel syndrome is causing weakness or loss of function. The surgery may also prevent further nerve damage and the resultant loss of hand function.

Types of Carpal Tunnel Release

There are two main types of Carpal Tunnel Release surgery:

• Open Release Surgery: This is the traditional method where the surgeon makes an incision in the wrist and palm to access the carpal tunnel and cut the transverse carpal ligament.
• Endoscopic Surgery: This is a less invasive method where the surgeon makes one or two smaller incisions and uses a tiny camera (an endoscope) to guide the surgical tools. The transverse carpal ligament is cut this way.

Both types of surgeries are generally effective, but recovery may be faster with endoscopic surgery.

Alternative Options to Carpal Tunnel Release

Before resorting to surgery, several less invasive treatments for carpal tunnel syndrome are usually tried. These include:

• Splinting or Bracing: This keeps the wrist in a neutral position, particularly during sleep, which can reduce pressure on the median nerve.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter drugs like ibuprofen can help reduce inflammation and pain.
• Corticosteroids are powerful anti-inflammatory medicines that can be taken orally or injected directly into the wrist to reduce inflammation and swelling.
• Physical Therapy: Specific hand and wrist exercises may be recommended. Some physical therapists may also use ultrasound therapy to reduce symptoms.
• Lifestyle Changes: Modifying certain activities or work practices to reduce unnecessary strain on the wrist.
• Ergonomic Adjustments: This might involve changing the setup of a computer workstation or using ergonomic tools.

What to do Before a Carpal Tunnel Release?

Your surgeon will provide you with specific instructions before surgery, but common recommendations might include the following:

• Avoid eating or drinking for a few hours before surgery.
• Stop taking certain medications if directed by your doctor, particularly blood thinners.
• Arrange for someone to drive you home after the procedure.
• Wear loose, comfortable clothing on the day of surgery.

Endoscopic Carpal Tunnel Release Surgery

Here's a basic overview of the endoscopic carpal tunnel release procedure:

• The patient is given a short-acting general anaesthetic.
• The surgeon will make a small incision (usually less than an inch) in the wrist. This is where the endoscope, a thin tube with a camera at its tip, will be inserted.
• The endoscope is carefully guided through the incision into the carpal tunnel. This allows the surgeon to visualise the interior structures on a video screen without making a large incision in the hand or wrist.
• The surgeon will use a small cutting tool inserted through the endoscope to cut the transverse carpal ligament, which forms the top of the carpal tunnel. This releases the pressure on the median nerve.
• The cutting tool and the endoscope are removed. The incision is closed with stitches. A bandage is applied.

What to Expect After a Carpal Tunnel Release?

After surgery, the hand will be in a heavy bandage for two days. The patient may be advised to elevate the hand and move the fingers to help reduce swelling and stiffness. Pain and numbness should begin to improve right after surgery, but full recovery may take months.

Carpal Tunnel Release Recovery Plan

The recovery process post-surgery varies from person to person, but a typical recovery plan may look like this:

• Pain Management: You may experience pain and discomfort after the anaesthesia wears off. Your doctor will provide you with a pain relief plan, including over-the-counter medications.  Prescription painkillers are usually not required.
• Physical Activity: You'll be encouraged to gently move your fingers and hand to promote blood circulation and prevent stiffness. Avoid heavy lifting and strenuous activity with the affected hand for a few weeks.
• Physical Therapy: Most people do not require physical therapy after carpal tunnel release.
• Follow-up Visits: You'll have follow-up appointments with your surgeon to monitor your progress and check for complications.

Carpal Tunnel Release Prognosis

The prognosis for carpal tunnel release surgery is generally good. Most people experience a significant reduction in their symptoms and improved hand function. However, the recovery time can vary. Some people may experience immediate relief, while others may take several months for symptoms to improve.

For some individuals, particularly those with severe or long-standing carpal tunnel syndrome, symptoms like numbness or weakness may persist even after surgery. Also, while rare, symptoms can recur in some people, requiring additional treatment.

Carpal Tunnel Release Risks

While carpal tunnel release is generally a safe procedure, as with any surgery, there are potential risks and complications. These may include:

• Infection
• Bleeding
• Damage to the median nerve or nearby nerves and blood vessels
• Allergic reaction to anaesthesia
• Persistent symptoms or recurrence of symptoms
• Scar sensitivity
• Complex regional pain syndrome - a rare but chronic condition that causes long-term pain.

What if Carpal Tunnel Release is Delayed?

Delaying carpal tunnel release surgery can result in worsening symptoms and permanent damage to the median nerve. This can lead to persistent numbness, loss of strength, and loss of hand function. Therefore, if non-surgical treatments aren't relieving symptoms, timely surgical intervention is crucial to prevent irreversible damage. As always, the decision to proceed with surgery should be made in consultation with your orthopaedic surgeon, weighing the potential benefits and risks.