Carpal Tunnel Release

Your hands and wrists are essential tools that allow you to work, play and perform everyday activities. How well the hand and wrist interact depends on the integrity and function of the ligaments, tendons, muscles, joints and bones.

Problems in any of these can affect upper extremity function, causing disruptions at home and work and negatively impacting quality of life.

The human hand itself is very complex and delicate in structure. Hand surgery requires a completely different surgical approach from a qualified hand and wrist surgeon whether treating fractures, arthritis or deformities. Hand surgery traditionally includes treatment of the entire hand, wrist and forearm.

Again, this whole region works as a single unit, and the dysfunction of a single part needs consideration of the whole. An additional year of training is required for those orthopaedic surgeons seeking certification in hand and wrist surgery.

At some time in life, you may experience hand and wrist pain.

Surgery has been proven very effective in the treatment of carpal tunnel syndrome, a procedure termed carpal tunnel release. This involves an incision in the palm of the hand and dividing the “roof” of the carpal tunnel. By dividing the “roof”, the space for the nerve is increased, and the pressure is thereby decreased around the nerve, leading to improvement of symptoms in the vast majority of cases.

The most common form of carpal tunnel release is the “open” technique. To perform this procedure, the surgeon creates a 2 – 4 centimeter incision across the middle of the palm. This entire procedure takes approximately 5 – 10 minutes, and can be performed under local anesthesia. The procedure can also be performed endoscopically, whereby a small incision is made in the wrist and in the palm and an endoscope is used to release the carpal tunnel.

Treatment

For most people, carpal tunnel syndrome will progressively worsen without some form of treatment. It may, however, be modified or stopped in the early stages. For example, if symptoms are clearly related to an activity or occupation, the condition may not progress if the occupation or activity is stopped or modified.

Nonsurgical Treatment

If diagnosed and treated early, carpal tunnel syndrome can be relieved without surgery. In cases where the diagnosis is uncertain or the condition is mild to moderate, your doctor will always try simple treatment measures first.

Bracing or splinting

A brace or splint worn at night keeps the wrist in a neutral position. This prevents the nightly irritation to the median nerve that occurs when wrists are curled during sleep. Splints can also be worn during activities that aggravate symptoms.

Medications

Simple medications can help relieve pain. These medications include anti-inflammatory drugs (NSAIDs), such as ibuprofen.

Activity changes

Changing patterns of hand use to avoid positions and activities that aggravate the symptoms may be helpful. If work requirements cause symptoms, changing or modifying jobs may slow or stop progression of the disease.

Steroid injections

A corticosteroid injection will often provide relief, but symptoms may come back.

Surgical Treatment

Surgery may be considered if you do not gain relief from nonsurgical treatments. The decision whether to have surgery is based mostly on the severity of your symptoms.

In more severe cases, surgery is considered sooner because other nonsurgical treatment options are unlikely to help.
In very severe, long-standing cases with constant numbness and wasting of your thumb muscles, surgery may be recommended to prevent irreversible damage.

The ligament is cut during surgery. When it heals, there is more room for the nerve and tendons.

Surgical technique

In most cases, carpal tunnel surgery is done on an outpatient basis under local anesthesia.

During surgery, a cut is made in your palm. The roof (transverse carpal ligament) of the carpal tunnel is divided. This increases the size of the tunnel and decreases pressure on the nerve.

Once the skin is closed, the ligament begins to heal and grow across the division. The new growth heals the ligament, and allows more space for the nerve and flexor tendons.

Endoscopic method

Some surgeons make a smaller skin incision and use a small camera, called an endoscope, to cut the ligament from the inside of the carpal tunnel. This may speed up recovery.

The end results of traditional and endoscopic procedures are the same. Your doctor will discuss the surgical procedure that best meets your needs.

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