Open Carpal Tunnel Release
The carpal tunnel is a narrow passageway on the palm side of your wrist. Small wrist bones known as carpal form the bottom and sides of your carpal tunnel and a strong band of connecting tissue, known as the transverse carpal ligament, covers the top of the carpal tunnel.
The carpal tunnel houses the flexor tendons, that allow you to bend your fingers, and the median nerve, which provides sensation to most of your fingers and hand.
Special tissues known as synovium surround and lubricate the flexor tendons in your wrist, allowing smooth movement of the fingers. Carpal Tunnel Syndrome occurs when the synovium swells, narrowing the limited space within the tunnel and pinches the median nerve over time.The transverse carpal ligament can also become tight, narrowing the carpal tunnel space and putting pressure on the median nerve.
Some of the common symptoms associated with Carpal Tunnel Syndrome include:
- Numbness and tingling in the thumb, index and middle fingers.
- Pain and burning in the hand and wrist that may radiate up the arm to the elbow.
- Decreased sensation and weakness in the hand with diminished grip strength.
- Worsening of symptoms at night.
The following factors have been known to increase a person’s risk of developing carpal tunnel syndrome:
- Repetitive Motion: Performing heavy, repetitive hand and wrist movements with prolonged gripping at work or play .
- Congenital: Some people are born with narrower carpal tunnel canals.
- Trauma: Injury to the wrist such as fractures or sprains.
- Hormonal Changes: Pregnancy, menopause, birth control pills or hormone pills are risk factors as they alter the levels of hormone in the body.
- Medical Conditions: Conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumor extending to the carpal tunnel.
Your doctor diagnoses carpal tunnel syndrome by reviewing a detailed medical history and physical examination. Further tests may be ordered including an X-ray to view your wrist bones, blood tests to rule out underlying medical conditions such as diabetes, arthritis and thyroid problems, and electro diagnostic testing to assess the speed and degree of electrical activity in your nerves and muscles.
Carpal tunnel can be treated with conservative measures or surgical intervention. Conservative treatment options may include treating any underlying medical conditions such as diabetes and arthritis. Your hand and wrist may be immobilized with a splint or wrist brace for 4 to 6 weeks. Ice packs may be recommended to keep down any swelling. You may be advised to avoid activities that tend to bring on the symptoms. Medication and steroid injections may be used to treat pain and swelling. You may be referred to therapy to be taught strengthening and stretching exercises.
When conservative treatment options are not effective, surgery may be recommended.
Open Carpal Tunnel Release Surgery is performed as an outpatient procedure. You will be given a local anesthetic to numb your hand and wrist. Your surgeon makes a 2-1/2 centimeter incision at the base of the palm. Retractors are then used to hold the skin edges apart in order to allow better visualization and exposure of the underlying tissues. The transverse carpal ligament is freed from its underlying tissue. A blunt guide with a groove on the upper surface is inserted below the ligament. This instrument protects the underlying nerve and tendons as it guides a knife along the tunnel. A special cutting instrument is then introduced through the guide and the transverse carpal ligament is cut. This widens the carpal tunnel and releases pressure from the median nerve. The wound is then irrigated. The operative incision is closed with sutures in such a way that the scar remains hidden in the natural crease of the palm. A small sterile dressing is then applied over the incision.
Following surgery, your wrist will be wrapped in a bandage or splint for about a week.
You will be started on a physical therapy program where you will be instructed on special exercises to improve the movement of your hand and wrist.
Some common post-operative guidelines include:
- Elevate your hand above the level of your heart to reduce swelling.
- Apply ice packs to the surgical area to reduce swelling.
- Keep the surgical incision clean and dry. Cover the area with a plastic wrap when bathing or showering.
- Eat a healthy diet and quit smoking to promote healing.
Risks and Complications
Some of the potential complications of carpal tunnel release surgery include:
- Damage to the nerves causing weakness, paralysis, or loss of feeling in the hand and wrist area.
- Stiffness to the wrist and hand.
- Wrist weakness and loss of strength due to the injured tendon.
- Worsening of symptoms or no improvement after surgery.