Surgery for Carpal Tunnel Syndrome
Surgery for the relief of Carpal Tunnel Syndrome (CTS) is the most common type of hand surgery, certainly in the USA, where more than half a million people are operated on for the condition in one year.
There is strong evidence which shows that CTS surgery is more beneficial to sufferers, than other more conservative forms of treatment. Trials have shown that between 70% – 90 % of patients who had surgery, was free of night time pain following the operation.
Typically patients who have the following characteristics are more likely to benefit from CTS surgery. –
- Those who have suffered for more than 10 months.
- They have a continual numbness of the wrist and associated area.
- Shrinkage is being experienced in the muscles at the base of the wrist
- The patient is older than 50 years, and the symptoms appear within 30 seconds of the patient being subjected to the Phalen’s test.
It is recognized that there are some factors which can affect the successful outcome of CTS surgery. Alcohol abuse, poor mental health, and diabetes can have a negative effect on the operation.
It has been shown also that people who are involved in jobs which entail the use of vibrating tools or have poor nerve conditions are less likely to experience a good outcome of such hand surgery. People who are on hemodialysis may have some favorable initial results from CTS surgery but the syndrome frequently returns within an 18 month period.
There are two types of hand surgery currently being used, open release surgery and mini-open surgery.
Open Release Surgery
This kind of surgery is usually carried out on an outpatient basis. It is a straightforward procedure which involves cutting the carpal ligament free from the compressed median nerve. The pressure on the nerve is thus relieved.
For sufferers of carpal tunnel syndrome (CTS), especially if it has become severe, and is affecting the use of the hand, medication has failed to resolve the problem, and the condition is deteriorating, then surgery can be used as a last resort.
But for people who opt for surgical treatment, they should be aware of the following:
- In rare cases, the median nerve has become so damaged that it can no longer function correctly, and the loss of sensations and weakness in the fingers will persist.
- Even though the operation has been carried out satisfactorily, the symptoms of CTS may return after a period of time.
- Following the surgery, the symptoms of pain and tingling usually will disappear, but the numbness in the fingers and palm may take longer to clear up.
The objective of this kind of surgery is to relieve the pressure on the median nerve by increasing the space in the carpal tunnel. It is a simple operation often performed in an outpatient clinic.
A choice of anesthetic is available, commonly three types are used:
- Local Anesthetic. The injection is administered to the hand where the incision is to be made.
- Regional Anesthetic. An injection numbs the entire arm.
- General Anesthetic. The patient is put to sleep.
The surgical procedure is designed to allow the median nerve unobstructed passage through the carpal tunnel by dividing the carpal ligament at the roof of the tunnel. The procedure is carried out in several short steps:
- A tourniquet is applied to the upper arm.
- A one-inch incision is made in the palm of the hand. Usually at the skin crease which extends from the palm to the wrist.
- The carpal ligament is then opened along its entire length exposing the median nerve in the tunnel.
When the surgeon is satisfied that the nerve is free from obstruction along the length of the tunnel, he will then close the wound.
Following the operation, the hand will be dressed with bandages or a plaster cast for up to two weeks, during which time the arm should be kept elevated by using a sling.
The stitches are usually removed after about 10 days, although some surgeons prefer to use absorbable sutures. When the dressing is removed exercising of the hand and fingers should begin. Start with gentle gripping exercises, and slowly work up to a stronger grip.
Normally it is possible to return to work after between 2 – 8 weeks depending on the severity of the condition treated, progress in rehabilitation, and the type of work involved. For people involved repetitive work a longer recovery time is strongly recommended.
Most surgeons opt for this kind of operation. A small incision is made at the site, usually about one-inch long. The carpal area is exposed and can be seen directly by the surgeon.
The operation is carried out in a similar fashion to open surgery, and the pressure on the median nerve is again relieved. While the result is the same as for open surgery, the recovery time is often quicker.
There is another type of surgery which can be administered known as Endoscopy, but there have been no greater advantages shown, and the procedure is more expensive.
After the initial incision has been made, a tiny camera is inserted via an endoscope, and the operation is conducted by the surgeon by viewing a monitor screen.
Surgery for Carpal Tunnel Syndrome, Last Updated: 30/7/2017