If you are dealing with persistent pain, numbness, or tingling in your hand, especially in the thumb, index, and middle fingers, you may have been diagnosed with carpal tunnel syndrome (CTS). When conservative treatments like rest, splinting, and anti-inflammatory medications fail to provide relief, carpal tunnel surgery might be recommended to help alleviate your symptoms and prevent further damage.
This guide provides an in-depth overview of carpal tunnel surgery, explaining what the condition is, how the surgery works, the benefits and risks, and what to expect during recovery. By the end of this guide, you will have a clearer understanding of the surgery and whether it could be the right option for you.
At Endoscopic & Minimally Invasive Spine Specialists, we have extensive experience and expertise with carpal tunnel surgery and provide the highest-quality care in surgical and non-surgical neurosurgical care.
To learn more about carpal tunnel surgery via minimally invasive approach, call the office today or request an appointment online.
This guide will help you understand the condition, the procedure, its benefits, risks, and the recovery process.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome occurs when there is increased pressure on the median nerve, which runs through a narrow passageway in the wrist called the carpal tunnel. The median nerve controls feeling and movement in the thumb, index, middle, and part of the ring fingers. The tunnel also contains tendons that help your fingers move, so any swelling or compression of the tunnel can lead to pain, numbness, and tingling in the hand and fingers.
The carpal tunnel is a tight space, and when the tendons and other structures inside it become inflamed or thickened, they press on the median nerve, leading to the symptoms of carpal tunnel syndrome. Common causes of CTS include repetitive hand movements (such as typing or assembly line work), wrist injuries, pregnancy, obesity, and certain underlying conditions like diabetes or rheumatoid arthritis.
Symptoms of Carpal Tunnel Syndrome
Carpal tunnel syndrome can range from mild to severe, and symptoms may worsen over time if left untreated. Common symptoms include:
- Numbness or tingling in the thumb, index, middle, and part of the ring fingers, especially when holding items or at night.
- Pain that radiates up the arm, often extending to the elbow.
- Weakness in the hand, making it difficult to grasp objects or perform everyday tasks.
- Clumsiness or loss of grip strength.
- Increased pain or discomfort when performing repetitive tasks or in certain wrist positions.
The symptoms may worsen at night or after repetitive activity, and many people experience relief by shaking their hands out or changing wrist positions.
When is Carpal Tunnel Surgery Recommended?
Most cases of carpal tunnel syndrome can be managed with non-surgical treatments, including:
- Wrist splints to keep the wrist in a neutral position.
- Anti-inflammatory medications to reduce swelling.
- Steroid injections to decrease inflammation around the carpal tunnel.
- Physical therapy or ergonomic changes to improve wrist posture.
However, if conservative treatments do not relieve symptoms, or if the condition progresses to the point where nerve damage occurs, your doctor may recommend surgery. Surgery is particularly necessary if you experience:
- Persistent or worsening numbness or pain.
- Weakness or atrophy of the muscles at the base of the thumb.
- Inability to perform everyday tasks due to hand weakness or pain.
What is Carpal Tunnel Surgery?
Carpal tunnel surgery aims to relieve pressure on the median nerve by cutting the transverse carpal ligament, a ligament that forms the roof of the carpal tunnel. By cutting this ligament, the tunnel becomes wider, creating more space for the nerve and tendons to move freely.
There are three main types of carpal tunnel surgery:
1. Open Carpal Tunnel Release Surgery: This is the traditional approach where the surgeon makes a small incision in the palm of the hand, near the wrist, to access the carpal tunnel and cut the transverse carpal ligament.
2. Minimally-Invasive Carpal Tunnel Release Surgery: This technique involves a 1.5 cm incision at the wrist and allows the surgeon to access the carpal tunnel to cut the transverse carpal ligament to decompress the median nerve. This approach results in dramatic improvement in function and early return to normal activities with minimal surgical pain. Nerve recovery after decompression depends on the severity and duration of compromise before surgery.
3. Endoscopic Carpal Tunnel Surgery: This is a minimally invasive technique where the surgeon uses a small camera (endoscope) inserted through a tiny incision to guide the cutting of the ligament. This approach often results in less pain and quicker recovery time. Disadvantages of this approach include two incisions (versus one), and increased time and cost for the procedure.
Each of these approaches aim to achieve the same goal—relieving pressure on the median nerve—but as with other minimally invasive surgery, these approaches typically have the advantage of smaller incisions, reduced scarring, and a quicker recovery period.
How Carpal Tunnel Surgery Works
Here is an overview of what to expect during the procedure:
1. Preoperative Planning: Before the surgery, your doctor will evaluate your symptoms and may order diagnostic tests like nerve conduction studies or ultrasound to confirm the diagnosis and assess the severity of the nerve damage. You will also discuss any allergies, medications, and anesthesia options.
2. Anesthesia: Carpal tunnel surgery is usually performed under local anesthesia, meaning the area around your wrist will be numbed, and you will be awake but comfortable. In some cases, you may be given sedation to help you relax. General anesthesia, where you are fully asleep, is less common but may be used in some cases.
3. Incision and Ligament Release: The surgeon will make a small incision (2 for endoscopic) near the wrist. The surgeon will then carefully cut the transverse carpal ligament to relieve pressure on the median nerve. Once the ligament is divided, the surgeon will check the nerve to ensure it is no longer compressed.
4. Closure: After the ligament is cut, the surgeon will clean the area and close the incision with sutures and skin adhesive. The wound is then covered with a sterile dressing, fluffs, and your arm placed in a sling to remind you not to use your hand for a few days.
5. Recovery: You will be taken to a recovery area where the anesthesia will wear off, and your hand will be monitored. You will go home the same day, although you will need someone to drive you.
Benefits of Carpal Tunnel Surgery
Carpal tunnel surgery is highly effective in relieving symptoms of CTS. Some of the main benefits include:
- Improved Nerve Function: By decompressing the median nerve, surgery can restore normal sensation and reduce numbness and tingling in the fingers.
- Pain Relief: Most patients experience significant pain relief after surgery, particularly those with chronic pain and severe symptoms.
- Improved Grip Strength: The surgery can help restore grip strength, which may have been compromised by CTS.
- Prevention of Further Nerve Damage: Surgery prevents the progression of nerve damage, which can lead to permanent weakness, muscle wasting, or loss of hand function if untreated.
Risks and Complications
As with any surgery, there are risks involved, although serious complications are rare. Some of the risks and complications include:
- Infection: There is a small risk of infection at the surgical site.
- Nerve Damage: Rarely, the median nerve or surrounding nerves may be damaged during the procedure, potentially leading to ongoing numbness or weakness.
- Scarring: Some patients may experience scarring or irritation at the incision site.
- Failure to Relieve Symptoms: In a small number of cases, surgery may not fully relieve symptoms or may require repeat procedures.
- Stiffness or Weakness: After surgery, some patients may experience stiffness or weakness in the hand or wrist, particularly if the condition has been present for a long time before surgery.
Recovery After Carpal Tunnel Surgery
Recovery time after carpal tunnel surgery depends on the type of surgery performed and your individual healing process. Here is what to expect during recovery:
1. Immediate Post-Operative Care:
- After surgery, you will have a bandage or dressing on your wrist to protect the surgical site. You will also have a splint and sling placed in the operating room to improve wrist position and limit your hand use for the first few days.
- Elevating the hand above heart level in the first few days can help reduce swelling.
- You may need to take pain medications including non-steroidal anti-inflammatory medications and tylenol, particularly in the first few days, to manage discomfort.
2. Return to Normal Activities:
- You will be encouraged to gently move your fingers and wrist soon after surgery to avoid stiffness and encourage healing.
- For open carpal tunnel release, you may need to wear a wrist splint for 1-2 weeks to immobilize the wrist.
- For minimally invasive surgery, the recovery period is faster with less need for splinting.
3. Follow-up Appointments: You will need follow-up appointments with your surgeon to check the surgical site, remove stitches (if necessary), and monitor healing.
4. Physical Therapy: Some patients may benefit from physical therapy to regain strength, flexibility, and mobility in the wrist and hand. Therapy can help speed up recovery and improve hand function.
5. Full Recovery: Full recovery typically takes about 6 weeks, although most patients may return to work and normal activities within days to a few weeks, particularly if they have a sedentary job. For more physically demanding jobs, you may need to wait longer.
Long-Term Outlook
Carpal tunnel surgery is generally highly successful, with most patients experiencing significant relief from symptoms and a return to normal function. However, it is important to continue ergonomic practices and avoid repetitive hand motions to prevent the recurrence of symptoms.
Contact EMISS to Schedule Your Procedure
Carpal tunnel surgery can significantly improve your quality of life by relieving the pain, numbness, and weakness caused by carpal tunnel syndrome. If you’ve been dealing with chronic symptoms and non-surgical treatments have not worked, surgery may be the right option for you. By understanding the procedure, potential risks, and the recovery process, you can make an informed decision and be better prepared for a successful recovery. Be sure to discuss your specific symptoms and treatment options with your healthcare provider to determine the best course of action for your needs.
To learn how you can benefit from carpal tunnel surgery and patient-centered care your neurosurgical and spinal problems, call Endoscopic & Minimally Invasive Spine Specialists today, or book an appointment online.
