What is carpal tunnel release surgery, and how does it work?
Carpal tunnel release (CTR) is one of the most common hand operations, and the results are usually curative. Major complications are extremely uncommon.
The transverse carpal ligament is a tight band deep in the palm at the level of the wrist. This ligament forms the roof of a tunnel bordered by the small bones in the wrist. This tunnel allows passage of 9 tendons and one nerve ( the median nerve) from the forearm into the hand. Any pathology that decreases space within the tunnel can compress the median nerve and cause symptoms of carpal tunnel syndrome. While it may seem illogical to purposely cut a ligament to improve hand function, long-term outcome studies have demonstrated continuous improvement of symptoms with few side effects.
The surgery is nearly always done as an outpatient procedure (i.e. you will go home the same day). We’ll go over what to expect before, during, and after surgery in this section.
What should I do to be ready for surgery?
You may be requested to go without food and drink on the day of surgery, depending on the type of anaesthesia used (more on this below). This usually means no food or drink after midnight the night before your procedure if you are having a general anesthetic.
Ask your surgeon for advice if you typically take drugs in the morning.
On the day of operation, what should I expect?
CTR can take place in a hospital, an ambulatory surgery facility, or even a clinic or a doctor’s office.
Documentation: Prior to surgery, you may be asked to sign certain paperwork, the most significant of which is the informed consent form. The concept of informed consent is that you and your surgeon have reviewed the risks and advantages of surgery and that both the physician and the patient agree to proceed with surgery.
Anesthesia: Anesthesia for CTR can be provided in a variety of ways, including the following:
A breathing tube is used in conjunction with general anaesthesia.
Sedation is a type of anaeshetic that makes you sleepy but you dont have a breathing tube inserted and is used in combination with some form of local anaesthetic for pain relief.
Local anesthetic with tourniquet.
WALANT: wide awake local anesthetic no tourniquet.Anesthesia administered locally (usually with lidocaine with adrenaline, similar to what is used for numbing your mouth for dental work)
By far the most common technique used in my practice is WALANT, it has the minimal risks and permits quick recovery and early return home.
All of these methods have advantages and downsides, which your surgeon and/or anesthesiologist will likely address on the day of surgery or during an office visit prior to surgery.
Fasting is essential for general anaesthesia and sedation, and an IV line must be established prior to operation. There is no need to fast if the surgery is performed with only local anaesthetic, and you will be awake throughout the process.
Patients frequently worry that if they are awake, they will feel the pain of the operation. You should feel no pain during the operation after the initial injection of lidocaine. You may feel the surgeon move your hand, and you may even feel touch, but the lidocaine blocks pain very well.
What may I expect following surgery?
Following surgery, engage in the following activities:
You’ll be sleepy after surgery if you’ve had general anesthesia and sedation, and you’ll need a ride home. For the rest of the day, you should plan on resting.
You should plan on doing only light activities for the rest of the day, regardless of the type of anesthetic you received (walking, eating, reading, TV).You’ll start to feel increasing pins and needles in your hand and fingers as the anesthetic wears off. The operation can cause numbness that lasts anywhere from a few hours to a day.
Summary:
Carpal tunnel release is a simple outpatient procedure that has a high success rate. The operation can be performed under general or local anaesthetic. Techniques that are both open and endoscopic are used. The endoscopic technique is more risky and reserved for specific indications only. Elevation and over-the-counter pain medications are used to manage pain following surgery.
You could be back in a few days or weeks, depending on your job. Light activities week 3 , heavy activities week 6.