What Is Open Carpal Tunnel Release Surgery
Open carpal tunnel release surgery is the traditional way of performing surgery to help treat pain and sensation loss from carpal tunnel syndrome by cutting off the pressure on the median nerve. It involves making a one- to- two-inch incision in the wrist which may vary depending on the patient.
This technique provides the surgeon a direct approach to see and cut the transverse carpal ligament resulting in immediate release of pressure from the median nerve. The incision is then closed with the help of sutures and stitches.
You will be able to leave the hospital on the same day of the procedure since the procedure is usually performed on an outpatient basis. After the passage of a defined healing period, your doctor may recommend hand rehabilitation therapy which is necessary in the process of rebuilding strength in your wrist.
All About Carpal Tunnel Release Surgery
Besides surgery there are many nonsurgical treatment options available for carpal tunnel syndrome. SeeTreatment Options for Carpal Tunnel Syndrome
Carpal tunnel release is small, outpatient procedure, but it is surgery nonetheless. Its important to know what to expect before and after the procedure, and how to prepare for it.
The surgery is usually performed by an orthopedic or plastic surgeon who specializes in hand surgery. The surgery takes less than an hour to perform and can be done under local anesthesia. Patients come in on the day of surgery and typically go home soon after the procedure.
What To Expect After Carpal Tunnel Release Surgery/operation
After your surgery, it may take several hours before the sensation comes back into your wrist and hand because of the administration of local anaesthetics. You should therefore be extra careful not to bump or knock your hand and keep yourself away from anything hot like kettles or radiators.
You may also expect a tingling feeling in your hand as the anaesthetic wears off and feeling returns.
To ease out any discomfort you may need pain relief medicines. You should have it even when your hand is still numb so that by the time your anaesthetic wears off they are in working condition.
You may have to put your hand and arm in a sling after the surgery to keep them elevated which helps in reducing any swelling you may have. To maintain a proper blood flow through your fingers and reduce any stiffness which appears in your hand, you should wriggle your fingers after a definite interval.
Your nurse will give you some advice about caring for your healing wound before you go home. You should prevent the wound and the area surrounding it from getting wet. Use a large rubber glove or plastic bag to cover the area when you are taking bath.
You will likely be allowed to leave the hospital once you feel ready. Your doctor may give you a date for a follow-up appointment.
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Preparation For Carpal Tunnel Release
Tell your health care provider what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.
- You may be asked to stop taking drugs that affect your bloods ability to clot. These include aspirin, ibuprofen , naproxen , and other drugs.
- Ask your health care provider which medicines you should still take on the day of your surgery.
- If you smoke, try to stop. Ask your health care provider for help. Smoking can slow healing.
- Let your health care provider know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
- You will usually be asked not to drink or eat anything for 6 12 hours before the procedure.
- Your health care provider will tell you when to arrive at the office. Arrive on time.
Signs & Symptoms Of Carpal Tunnel
Symptoms of carpal tunnel syndrome usually arise in the thumb, index, middle, and ring fingers. They may include:
- Burning pain
- Trouble pinching, grasping, or holding onto objects
- Difficulty using the thumb
In severe cases, carpal tunnel syndrome can cause a complete loss of strength in the thumb muscles. Because the median nerve typically does not affect the little finger , symptoms experienced in this finger may indicate another condition. A ligament tear, thumb arthritis, or tendinitis may occur at the same time as carpal tunnel syndrome, and our hand surgeons have a wide array of treatments designed for these and other conditions.
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What To Expect During Carpal Tunnel Surgery Recovery
Immediately after the procedure, it’s important to keep the incision clean and dry for two weeks. It’s also important to restrict heavy lifting.
The timetable for post-surgery recovery can vary, depending on the severity of your condition, how smoothly the healing process goes and how well you rehabilitate your hand.
“Finger flexibility is key for recovery after carpal tunnel surgery,” says Dr. Alexander. “Whether typing on a keyboard, or just trying to make a fist, you want to get your fingers moving.”
She adds that swelling can slow your recovery so let your doctor know if your post-surgery swelling seems excessive or lasts longer than expected.
“Some people experience relief as soon as a few weeks to months after carpal tunnel surgery, especially for the night-time symptoms,” says Dr. Alexander. “However, it can take up to a year to see complete improvement.”
Will Carpal Tunnel Syndrome Ever Go Away
Carpal tunnel syndrome is a condition marked by pressure on the median nerve of your wrist and hand. This syndrome can be treated with surgical and nonsurgical treatments, depending on the severity of the condition. However, it is important to understand that carpal tunnel syndrome is not absolutely curable but can be managed with various treatment options. With the correct and suitable treatment, the patient will get relief from constant pain and other symptoms caused due to the condition.
In some cases, if the carpal tunnel syndrome is mild and it is diagnosed early, it may go away on its own with rest. For patients experiencing severe or frequent episodes of pain and other symptoms, surgery seems to be the most suitable and successful mode of treatment as it provides permanent relief from the symptoms in the majority of the cases. Rarely does a patient require a revision surgery after a successful carpal tunnel release surgery.
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Final Months Of Aftercare
The final phase of your aftercare can last for a couple months up to a year. It depends on you, including your ability to heal and the amount of effort you put into rehabilitation and strengthening your hand.
If your job doesnt require a lot of manual work, then returning to work will be relatively easy but you may need to take occasional short breaks for hand rests. Again, this assumes you experienced no surgical complications.
Finally and this may sound odd but pay special attention to yourjob function.Thats because carpal tunnel syndrome is an occupational disease. That means the job probably allowed the condition to develop in the first place. High-risk jobs that require a lot of forceful and repetitive hand movements.
What Is The Recovery Timeline For Carpal Tunnel Release Surgery
Exact recovery time can vary widely for those who have a carpal tunnel release surgery depending upon the speed of their recovery. In addition, various factors can impact the recovery time such as patient age and other health factors, severity of carpal tunnel syndrome prior to the surgery, and the ability of the patient to follow up the post-operative guidelines and recommendations.
Usually, you can expect the following stages during your recovery period after the carpal tunnel release surgery:
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What Happens After Carpal Tunnel Surgery
Your wrist will likely be in a heavy bandage or a splint for 1 to 2 weeks. Doctors usually schedule another appointment to remove the bandage or splint. During this time, you may be encouraged to move your fingers to help prevent stiffness.
You’ll probably have pain in your hand and wrist after surgery. It’s usually controlled with pain medicines taken by mouth. The surgeon may also have you keep the affected hand elevated while sleeping at night to help decrease swelling.
Once the splint is removed, you will likely begin a physical therapy program. The physical therapist will teach you motion exercises to improve the movement of your wrist and hand. These exercises will speed healing and strengthen the area. You may still need to sometimes use a splint or brace for a month or so after surgery.
The recovery period can take anywhere from a few days to a few months. In the meantime, you may need to adjust job duties or even take time off from work while you heal. Your doctor will talk to you about activity restrictions you should follow after surgery.
Let your doctor know about any of the following:
- Redness, swelling, bleeding, or other drainage from the incision
- Increased pain around the incision
These problems may need to be treated. Talk to your doctor about what you should expect and what problems mean you need to see your doctor right away.
Preparation For Carpel Tunnel Release Surgery
Carpal tunnel release surgery is an outpatient procedure, meaning you can have the procedure and go home the same day. Before having the operation, you should let your doctor know about the medications, including any supplements and natural remedies, that you have been taking, with or without a prescription.
- You should ask your doctor about the medicines that you can continue taking up to the operation date.
- Your doctor might ask you to stop taking blood-thinning drugs. These include naproxen, aspirin, and ibuprofen, among others.
- In case you smoke, you will be asked to try and stop, because smoking is known to slow down your body’s healing processes.
- You should let your doctor know if you have other illnesses or diseases such as herpes, the flu, fever, or a cold.
- You should not eat or drink anything 6 hours before surgery.
You should follow all your doctors’ instructions to the letter so that the operation and your recovery go smoothly. Your doctor will tell you what time you have to be in the hospital for the operation. Make sure you arrive on time.
Other things to ask your doctor about the surgery include:
In both surgical methods, a certain sequence needs to be followed:
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What Are The Risks And Potential Complications Of Carpal Tunnel Surgery
As with all surgeries, carpal tunnel release involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
Complications of carpal tunnel release are uncommon but include:
Adverse reaction or problems related to sedation or medications, such as an and problems with breathing
Types Of Carpal Tunnel Release Surgery
Sometimes symptoms just dont go away. So if all non-surgical remedies failed AND the severe symptoms lasted for over 6 months, yourcarpal tunnel doctormay recommend hand surgery.
There are twobasictypes or “procedures” used for carpal tunnel release surgery:
The types of surgery relate to the basic ways to cut that ligament. One way is to slice the palm open to expose the ligament. Another way is to insert a thin tube into the wrist to do the same thing.
Usually, patients having the “open” technique will also have general anesthesia, where you’re put to sleep. In contrast, about half of “endoscopic” patients are wide awake during the procedure. But their hand and arm are numbed with an anesthetic injection.
We’ll discuss more details about open and endoscopic carpal tunnel release surgery below.
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What Are My Surgery Options
There are two main types of carpal tunnel release surgery: open and endoscopic. In both cases, your doctor cuts the ligament around the carpal tunnel to take pressure off the median nerve and relieve your symptoms. After the surgery, the ligament comes back together, but with more room for the median nerve to pass through.
- Open surgery involves a larger cut, or incision — up to 2 inches from your wrist to your palm.
- In endoscopic surgery, your surgeon makes one opening in your wrist. They may also make one in your arm. These cuts are smaller, about a half-inch each. They then place a tiny camera in one of the openings to guide them as they cut the ligament.
Because the openings are smaller with endoscopic surgery, you may heal faster and have less pain. Ask your doctor which operation is best for you.
First Month Of Aftercare
What a relief! Those itchy stitches and bandages are gone. Your patience has paid off, but you still you have:
- a tenderness in the wrist
- an itchy scar
- pain when gripping or pinching
These feelings are completely normal and will lessen in the next few weeks.
At this point,scar managementbecomes important. Keep the scar clean and dry. You can gently massage the scar and surrounding skin with vitamin C + E cream.
In this period of aftercare for carpal tunnel surgery most patients report reduced grip and pinch strength. This is also normal. At first it will be too painful to grip or pinch anything firmly. Thats why you must do this slowly and work up to harder gripping strength. If you dont have the complication of nerve damage as a result of the surgery, grip and pinch strength should be back to normal in 3 months.
This is also the time to beginhand therapy after carpal tunnel surgery.Stretching, strengthening, and range of motion exercises are all part of the physical therapy your hand will need. The surgeon will give you instructions for all of these.
You will also do more vigorous activities with your hand. This is the period of aftercare for carpal tunnel surgery where most patients can return to work.
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What Is Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The carpal tunnela narrow, rigid passageway of ligament and bones at the base of the handhouses the median nerve and the tendons that bend the fingers. The median nerve provides feeling to the palm side of the thumb and to the index, middle, and part of the ring fingers . It also controls some small muscles at the base of the thumb.
Sometimes, thickening from the lining of irritated tendons or other swelling narrows the tunnel and compresses the median nerve. The result may be numbness, weakness, or sometimes pain in the hand and wrist . CTS is the most common and widely known of the entrapment neuropathies, in which one of the bodys peripheral nerves is pressed on or squeezed.
What Is Endoscopic Carpal Tunnel Release Surgery
Endoscopic release surgery, also known as laparoscopic or keyhole surgery, refers to the indirect approach with the use of specialized instruments and cameras to dissect the transverse carpal tunnel ligament and make room for your median nerve.
Usually, your surgeon will make one or two small incisions in the wrist near the transverse carpal ligament. Afterwards, a small tube is temporarily inserted into the operation area for housing other instruments during the surgery which are used to visualize and then to cut the transverse carpal ligament. The tube and other instruments are removed after the release of the ligament and the incision site is closed with stitches.
The endoscopic surgery may have faster recovery times because the incision made is smaller in this technique in comparison to the open technique. Open carpal tunnel release surgery is generally recommended if your surgeon is not able to see the entire transverse carpal ligament using the endoscopic equipment or if it is a repeat procedure.
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Endoscopic Carpal Tunnel Release Surgery
With endoscopic carpal tunnel release surgery, there are two sub-types:
- Surgery was on your dominant hand.
- Open carpal tunnel release surgery was performed.
- Youroccupationrequires a lot of hand activity.
- Your overall health is poor or you have a chronic disease .
- You’re a smoker.
Most people take 1-2 months off work after open release surgery. Compare that with 7-10 days for endoscopic surgery.
In general, open release surgery needs more post-surgical therapy and rehab than either type of endoscopic procedure. But in every patient, it takes a commitment to hand therapy to recover good hand strength. And that can take many months or even years.
The results of carpal tunnel release surgery breaks down as follows:
- About a third of patient who have surgery see symptoms disappear right away. But full recovery can take many months.
- Anotherthird can take several months to see relief.
- An unfortunate third do not see a difference in symptoms at all. About half of them even see symptoms get worse.
Particularly with the open release technique, thescarmay feel tender for up to one year. Loss of grip and pinch strength happens right after surgery, whichever procedure is used. But it usually recovers within a few months after the surgery.
What Does Carpal Tunnel Treatment Involve
For milder symptoms, treatment usually involves wearing a splint at night to keep the wrist in a neutral position, thereby preventing night awakening from numbness and tingling. As symptoms progress, your surgeon may offer you either injections or surgical treatment. Surgery is the definitive treatment for carpal tunnel syndrome. It is a minor procedure with a relatively easy recovery that leads to a huge improvement in quality of life and function by eliminating tingling and pain. The surgery is an outpatient procedure, and it can be done with wide-awake-hand-surgery or with light sedation.