Carpal tunnel release

Carpal tunnel release is a surgical treatment for carpal tunnel syndrome, aimed at releasing pressure on the median nerve by cutting the transverse carpal ligament.

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What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition caused by a pinched nerve in the wrist. The carpal tunnel itself is a narrow path at the base of your palm, made of bone and ligament. If there is a swelling in your wrist for any reason, there is pressure on the tunnel, causing the median nerve to get pinched.

Tunnel syndromes can also occur in the elbow (cubital tunnel syndrome), in the groin area, below the knee, or in the foot.

What causes carpal tunnel syndrome?

Carpal tunnel syndrome can be associated with many conditions involving pressure on the medial nerve. This pressure is usually caused by inflammation and swelling which – often associated with the following conditions:

fractures or trauma to the wrist
thyroid problems
autoimmune diseases such as diabetes and rheumatoid arthritis
high blood pressure
fluid retention from pregnancy or menopause

Furthermore, any activity involving prolonged pressure, exposure to vibrations and overextension – such as typing, playing the piano, use of hand tools – can also contribute to the swelling of the tendons.

What are the symptoms of carpal tunnel syndrome?

When the tendons, running through the carpal tunnel, swell, they compress the median nerve. The median nerve is responsible for sensation in most of the fingers. As a result of the condition, various neurological symptoms can occur in the area, including numbness, tingling, pain, weakened grip and clumsiness. Numbness and tingling are usually felt in the thumb, index, middle and ring fingers. The symptoms are usually worse during the night, but at later stages they can also interfere with daytime activities. The wrist is often swollen and sensitive to pressure. Patients may complain of pain radiating to the forearm, shoulder or neck.

If the condition is not treated, the muscles receive insufficient nervous stimulation over time, which may lead to weakness and muschle atrophy in the thumb.

Carpal tunnel syndrome usually affects the dominant hand.

Numbness in the hand - carpal tunnel syndrome

How is carpal tunnel syndrome diagnosed?

Carpal tunnel syndrome is most often diagnosed by orthopedists. A combination of your medical history, a physical examination in and electrodiagnostic testing will be used to confirm the root cause of your complaints.

As disk herniation and certain disorders of the circulatory system can mimic the symptoms of carpal tunnel syndrome, a special test called electroneurogram (ENG) is recommended to confirm the diagnosis.

ENG is a type of nerve conduction study, designed to measure the conduction speed of your nerve impulses. If the nerve impulse is slower than normal as the nerve passes into the hand, you may have carpal tunnel syndrome. ENG is usually used to confirm a suspected the diagnosis.

What treatment options are there for patients suffering from carpal tunnel syndrome?

The symptoms of carpal tunnel syndrome can often be relieved with conservative treatment alone. Wrist braces and medication are the first line of treatment. Braces (or splints) help reduce the pressure on the median nerve, while steroid injections to the carpal tunnel reduce swelling.

However, if these treatments prove to be unsuccessful, surgical release of the nerve is the safest, fastest and most effective way to deal with carpal tunnel syndrome.

When is carpal tunnel release recommended?

If conservative treatment doesn’t alleviate the symptoms, the patient is in severe pain, or there is damage or risk of damage to the median nerve, surgical treatment is recommended.

What happens during the surgery?

During your first appointment your orthopedic specialist will provide you with detailed information regarding the preoperative tests you need to undergo, the surgery itself (techniques, potential risks and recovery), and aftercare.

At our hospital carpal tunnel release is performed as outpatient surgery. After preparation, local anaesthetic is injected into the hand, then the wrist is cut open and the transverse carpal tunnel ligament is divided. The surgeon then closes the wound with a few stitiches, leaving the ends of the ligament loose. The whole procedure takes about 20 minutes.

Are there any risks associated with this type of surgery?

Carpal tunnel release is a very safe procedure. However, as with any surgical intervention, there are some risks and possible complications to take into account before making a treatment decision. On rare occasions the surgical site may become infected and the resulting inflammation can spread to the surrounding tissue, potentially affecting tendons, muscles, blood vessels, nerves and bones. In most cases pharmaceutical treatment is sufficient to control the infection, but in severe cases further operation may become necessary.

What to expect after surgery?

After a few hours of monitoring, you will be ready to leave the hospital, the bandage has to be changed on the next day. In the first few days light physical exercises of the hand, wrist, and fingers are recommended. Stitches removal takes place 10 days after surgery. Until then your hand should not come into contact with water. The wound may remain swollen for a couple of days after surgery. You may also experience numbness and pain which can be managed with OTC pain medication. It may take a few months until your hand is fully functional, physiotherapy can help to speed up your recovery.