Definition of Carpal Tunnel Release
Carpal tunnel release is a surgical procedure that relieves symptoms caused by carpal tunnel syndrome. The syndrome is caused by median nerve compression in the wrist, which results in pain, weakness, and/or numbness of the hand and fingers.
Who needs carpal tunnel surgery?
If you have pain and tingling in your hand or fingers, you may have carpal tunnel syndrome. It is a very common syndrome and sometimes can be caused by repetitive movements or a former wrist injury. It is a progressive problem that often is more bothersome at night, often waking patients from their sleep with burning and numbness. In early cases splinting alone and anti-inflammatory medicine will often improve the symptoms; however, when splints fail and patients have nerve conduction studies that are positive and any muscle wasting, surgery is necessary to prevent further wasting of the muscle and to regain sensation and relieve pain. Sometimes patients have can develop this because of highly repetitive activities such as prolonged typing without a wrist support or cycling or even jack-hammering in the construction industry.
Open vs. Endoscopic Carpal Tunnel Release
There are two basic surgical procedures referred to as “open” and “endoscopic”. Open carpal tunnel surgery is the original procedure that involves a small incision in the base of the palm for a direct decompression of the median nerve. No camera is needed in this case since the surgeon can see all structures directly. The transverse carpal ligament is then cut to release the pressure on the nerve which passes beneath it. The entire procedure usually takes approximately 30 minutes. If there is swollen tissue, or if you have arthritis, Dr. Boynton may want to remove some of the tissue that surrounds the nerve to further release the pressure. You may be asleep under a general anesthetic during surgery, or you may be partially awake under a sedative and a local anesthetic to numb the wrist. In either circumstance, you will feel no pain during the procedure, and you should be able to go home within a few hours of surgery. You will need someone to drive you home, however, and you will need help around the house for the first few days, as your wrist movements will be restricted initially.
The endoscopic approach is the technique I prefer and most often perform. This involves a small incision at the wrist crease and involves a small fiberoptic camera attached to a monitor which is inserted so that Dr. Boynton can see what he is doing without having to make a large incision or disturb the surrounding tissue in order to release the nerve. This procedure really should be performed by a fellowship trained hand surgeon that has advanced training in this procedure.
The advantages of this procedure are less pain, a smaller, well-disguised incision, and recovery in about half the time. The usual recovery for an open carpal tunnel surgery is about 6 weeks, while the recovery after endoscopic carpal tunnel surgery is about 3 weeks. Sometimes a few sessions of postoperative hand therapy are needed afterwards but this is rare with the endoscopic procedure.
Recovery After Carpal Tunnel Surgery
Patients that have endoscopic carpal tunnel release do not require a splint which patients are happy about. They have a soft gauze wrap that they are required to wear for a week, and after that nothing at all. The tiny wrist incision heals well and is hardly noticeable. A single suture is removed in the office after the third week from the wrist. Patients that have open carpal tunnel surgery usually will wear a splint for a week, and a soft gauze dressing for two more.
The symptoms of pain, numbness, and burning in the hands are usually relieved by carpal tunnel release. Oftentimes, hand strength is also improved; however, in patients that have more severe carpal tunnel syndrome and advanced muscle wasting (atrophy), they usually will not get much of their strength back, but the surgery will keep it from advancing further and getting worse. Full recovery usually can be expected at about three weeks with the endoscopic carpal tunnel release and about six weeks with the open (traditional) release.
If the etiology of the patient’s carpal tunnel syndrome is suspected to be the result of repetitive movements, Dr. Boynton will give you instructions on things that can be done to lessen the chance of a recurrence of the syndrome. For example, if you are a typist, often typing in wrist splints and utilizing an ergonomic wrist bar or support to keep the wrist from flexing lessens recurrence.
Carpal tunnel release is a very safe surgical procedure with a low rate of complications, and complications are unusual. There is a small rate of recurrent carpal tunnel that sometimes needs revision surgery. In extremely rare cases, the nerves can be injured during the surgery, or the surgery can fail to eliminate the symptoms experienced prior to surgery. With regard to the endoscopic carpal tunnel release, it is important to seek out a fellowship trained hand surgeon that has done many of these procedures in order to get the safest results and lowest chance of injury to the median nerve.
Schedule a Consultation for Carpal Tunnel Syndrome Treatment
If you think you may be suffering from Carpal Tunnel Syndrome, please contact our practice. Dr. James F. Boynton can meet with you in an initial consultation and discuss your options for treatment.
Boynton Plastic Surgery1900 St. James Place Suite 200 Houston, TX 77056
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