Carpal Tunnel Surgery

Carpal tunnel surgery is defined as one of the solutions used by the orthopedic surgeon to relieve the pressure on the median nerve in the carpal tunnel. Pressure on the nerve causes tingling, numbness and pain in the hand and fingers, which impedes free movement. Surgical options may include either a traditional or laparoscopic method to release the median nerve, depending on the patient's condition and as determined by the surgeon.

Orthopedic surgeons resort to surgical procedures after medications fail to relieve pain and the patient does not respond effectively.

Carpal tunnel surgery is mainly aimed to release the median nerve (Median Nerve) and restoring the natural sensation of the hand, in addition to the following sub-reasons:

• The patient does not respond to medications and continues to feel pain.
• The muscles of the hand and wrist tend to become smaller as a result of intense nerve compression.
• Carpal tunnel problem continued for more than 6 months.
• The inability of the patient to hold things as before.
• Feeling numb and tingling in the hand and fingers.

The patient undergoes a series of tests before the carpal tunnel surgery, including:

• Clinical examination.
• Electrophysiological tests to check the median nerve.
• Ultrasound for carpal bones and soft tissues in the wrist.
• X-rays to diagnose carpal bones in the wrist.
• Laboratory tests, such as blood and urine tests.
• Electrocardiogram (ECG).

Patient preparation: 

Patients are required to refrain from taking blood thinners such as warfarin and other medications prescribed by the specialist. Also, the patient should avoid smoking for approximately two weeks before the date of the surgery; to improve the chances of recovery and healing. 

The patient should refrain from food and drink 6-12 hours before the surgery.

The surgery of the carpal tunnel includes the following steps according to the method used as follows:

• Traditional Carpal Tunnel Surgery:

1. Anesthesia of the patient (general or local anesthetic).
2. Make an incision in the wrist area approximately 2 inches long.
3. Use specific surgical instruments to cut the carpal ligament covering the median nerve and expand the carpal tunnel to release the nerve.
4. Stitch the incision and cover it with a bandage and splint to prevent it from moving for a certain period.

• Laparoscopic Carpal Tunnel Surgery:

1. Anesthesia of the patient (general or local anesthetic).
2. Make two incisions, one in the wrist and the other in the palm, each about half an inch wide.
3. Insert a tube through one slit holding a camera at its tip and insert another tool from the other slit to cut the carpal ligament and expand the tunnel into the wrist.
4. Close the incisions with stitches and cover them with a bandage and splint to prevent him from moving for a certain period as the surgeon thinks appropriate.

Carpal tunnel surgery involves a range of problems and complications as well as other surgeries, whether associated with anesthesia or with the surgery itself, from these complications and problems:

• Bleeding.
• Infection.
• Injury to a nearby blood vessel.
• Injury of the median nerve itself.

Patients often can leave the hospital on the same day after carpal tunnel surgery.

The patient may regain normal movement of his hand approximately one to two weeks after the carpal tunnel surgery. 

During this period, the patient may experience some pain that may be controlled by taking pain medication prescribed by the responsible orthopedic surgeon.

During the recovery, the patient is advised to continue moving the fingers to avoid stiffness, as well as to raise them during sleep to avoid swelling. After the splint is removed, the patient may rely on a physiotherapist to help in some hand exercises to gradually restore movement.

The patient's adherence to the advice given by the surgeon will help to speed up the healing period.

(Will be added soon, God willing)

• Trigger finger surgery
• Wrist arthroscopy 
• Elbow arthroscopy

--------------------

Last updated on 29 December 2021

--------------------

1. Carpal tunnel syndrome. (2020). Retrieved from Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/4005-carpal-tunnel-syndrome
2. Open carpal tunnel surgery for carpal tunnel syndrome. (2020). Retrieved from University of Michigan Health: https://www.uofmhealth.org/health-library/hw212359
3. Faust, K. and Jennings C. (2016). Carpal tunnel syndrome, Retrieved from OrthoInfo: https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/
4. Wheeler T. (2021). Do I need carpal tunnel surgery? Retrieved from WebMD: https://www.webmd.com/pain-management/carpal-tunnel/do-i-need-carpal-tunnel-surgery
5. Carpal tunnel release. (n.d.). Retrieved from Johns Hopkins Medicine: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/carpal-tunnel-release