Carpal Tunnel Syndrome Surgery

Hello, my name is Dr. Alexander Anzarut. I’m a plastic surgeon and a hand surgeon. After completing my residency in plastic surgery at the University of Alberta, I completed a hand surgery fellowship at the University of Pittsburgh. This article is designed to help you understand about carpal tunnel syndrome, what this condition is, what the treatment options are and what to expect if you have treatment for carpal tunnel syndrome. I advise you to watch the video before your appointment; that way, you can be best prepared for the consultation.

What is Carpal Tunnel Syndrome?

Inside the wrist, there is a space – a tunnel or a pipe – that we call the carpal tunnel. Inside that tunnel are nine tendons. These nine tendons, I have just outlined in blue. With use and with age, the nine tendons thicken. As they thicken, there is more stuff or more volume inside the tunnel. As a result, the pressure inside the tunnel increases. The only other thing inside the tunnel is a nerve known as the Median nerve. As the pressure in the tunnel increases, the nerve is compressed, and the nerve is starved of oxygen, leading to carpal tunnel syndrome.

Initially, patients may wake with symptoms of numbness and tingling and discomfort in the hand. As the condition progresses, one may have numbness and tingling in the hand that occurs in the daytime. It usually involves the area of the thumb, the index finger or pointer finger, the long finger, and the ringer finger. Initially, this numbness and tingling is intermittent, however, as the condition progresses, it becomes more common and eventually may become constant. Once the nerve is constantly starved of oxygen due to the high pressure in the carpal tunnel, parts of the nerve can die off. As a result, patients may end up with permanent numbness and tingling that cannot be reversed.

Who Should Consider Carpal Tunnel Surgery?

In this segment, I would like to discuss the indications for carpal tunnel surgery. In general, patients who have constant numbness or tingling should undergo carpal tunnel surgery to avoid permanent damage to the hand. Patients who have thumb muscle weakness due to carpal tunnel syndrome should have carpal tunnel surgery to avoid further permanent damage to the hand. The type of thumb muscle weakness caused by carpal tunnel syndrome is often seen as wasting or slimming of the muscle in this area. Patients will also often have trouble doing this motion with the thumb – moving the thumb away from the palm. Many people without these symptoms will also choose to go through carpal tunnel surgery in order to avoid worsening of their symptoms and protect the nerve or because the carpal tunnel syndrome for them is impairing their ability to work or to have a satisfying quality of life.

What is Carpal Tunnel Release Surgery?

Surgical treatment of carpal tunnel involves decreasing the pressure inside the carpal tunnel. This circle that I’m outlining in blue represents the carpal tunnel. Surgery is quite straightforward for myself, the surgeon. It is done under local anesthetic and takes approximately five to 10 minutes.

An incision is made at the roof of the tunnel. As a result, the tunnel opens and enlarges, leading to decreased pressure in the nerve and a healthier nerve. Over time, the tunnel scars closed, however, it stays enlarged and carpal tunnel syndrome should not return.

The carpal tunnel itself is located in the palm. This diagram shows the location of the roof of the carpal tunnel. The second diagram is a closeup of the roof of the carpal tunnel. This is also known as the transverse carpal ligament. The Median nerve or the nerve that is compressed in carpal tunnel syndrome runs in the tunnel underneath the roof of the tunnel, or underneath the transverse carpal ligament.

The goal of carpal tunnel surgery is to release or open the top of the tunnel without injury to the nerve. An incision is made in the palm from here to here through the skin. Once through the skin, an incision is made to release the transverse carpal ligament. Once this is done, the carpal tunnel release is complete, and the skin is sutured closed.

Risks and Benefits of Carpal Tunnel Surgery

As with any surgery, there is potential for complications. The chance of a complication after carpal tunnel release is much less than 1%, it is a very safe procedure overall.

Possible complications include:

Injury to the nerve itself. This could cause weakness in the thumb or numbness in the fingers and thumb.
Patients can develop an infection.
Patients can develop stiffness.
And they can develop pain after surgery.

It is important to realize as well, that symptoms that are not caused by carpal tunnel, but may be caused by other conditions in the hand, such as tendonitis or arthritis will not be improved with carpal tunnel surgery.

The potential benefits for carpal tunnel surgery are great for those individuals who are suffering from carpal tunnel syndrome:

Almost immediately, patients should be able to sleep again at night without waking, without having the discomfort that wakes them at night.
Numbness and tingling that occurs during the daytime will improve, however, this takes longer. Maximal improvement can take 12 to 24 months. And for those individuals who have already sustained permanent damage to the nerve, full recovery may not be possible.

What to Expect After Carpal Tunnel Surgery

The most important thing in considering carpal tunnel surgery is to understand the side effects of the surgery itself. After the surgery, there’s some discomfort and patients generally require a Tylenol 3 or similar painkiller the night of surgery and the next morning. After that, they are usually able to take a plain Tylenol or an anti-inflammatory once or twice or three times a day for the next two to five days.

For the first 48 hours after surgery, it is very important to reduce swelling and inflammation. This helps long-term recovery. It is important to ice the hand while awake, 15 minutes on and 15 minutes off. It is important to keep the hand elevated above the level of the heart relative to the ground.

This means:

Keeping the hand at chest level or slightly higher while walking.
Keeping the hand at chest level or slightly higher while sitting.
Keeping the hand anywhere adjacent to the body while lying down or sleeping.

For the first two weeks after surgery, it is very important not to use the hand. For this reason, many people try to plan the surgery around a time when there may be someone around to help.

Week 1 to week 2: You will open and close your hand to keep it moving and avoid stiffness, but you will not be using your hand. You will be in a splint. Leave the splint on and keep it dry. If you shower use a plastic bag around the splint to keep it clean. If the splint becomes too tight from swelling remove it and re-apply this more loosely.
Week 2 to week 4: You can start to use the hand for basic activities. This includes anything that involves grip or lifting up to two pounds. At four weeks, you can start using your hand more and more. At this point remove the splint. Wash soak with hydrogen peroxide for 2 minutes using a clean paper towel. Pat the area dry and cover the incision with a clean bandage.
Week 6: You should be able to do everything and anything that you would like to do with your hand.

However – and this is extremely important – for the first six months, on average, there are ongoing symptoms. The place where the incision is on the palm is often sensitive to touch. With heavy lifting or gripping, the muscle at the base of the thumb and the muscle at the base of the small finger will be crampy. This does not mean you’ll be restricted in your activities; however, you will notice that things don’t feel quite right. And this lasts on average, for six months.

Avoiding Infection After Carpal Tunnel Surgery

The other thing that is very important is to avoid infection. For the first two weeks after surgery, you will have a small dressing on your hand and a splint to prevent wrist motion. This should stay on. After two weeks, you will take the dressing off and you will be able to get the hand wet in the shower. At this point remove the splint. Wash soak with hydrogen peroxide for 2 minutes using a clean paper towel. Pat the area dry and cover the incision with a clean bandage. This should continue for 2 more weeks. This is very important to avoid infection.

It is also very important to avoid sitting water. Therefore, during the first four weeks, patient should avoid baths, hot tubs, swimming pools, dishes, and gardening. Even if you use gloves to protect your hand, you may get an infection. If you need to do something where you’re worried your hand may be exposed to potential infectious material, it’s important to make sure that you have your waterproof dressing on and also use a disposable one-time use glove to keep your hand clean. For example, one of these latex gloves.

I hope this video has been informative and helpful in understanding a little bit about carpal tunnel syndrome and carpal tunnel surgery.