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Carpal Tunnel Syndrome - Surgical Treatment, Diagnosis, Benefits & Risks

Carpal tunnel syndrome surgery, also known as carpal tunnel release is a minimally invasive surgery in which the surgeon uses an endoscope to release the pressure on the median nerve.

The surgeon creates an incision on the patient’s palm over the carpal tunnel ligament and cuts through the ligament to gain access to the surgical site. Then, the surgeon cuts the excess part of the ligament and release the pressure on the affected area to provide pain relief.

Diagnosis of Carpal Tunnel Syndrome

An orthopedic surgeon conducts a thorough diagnosis for carpal tunnel syndrome to assess the severity of the condition. The diagnosis includes a physical examination in which the orthopedic surgeon performs nerve conduction studies for the hand, shoulder, wrist, neck, and other body parts that can cause nerve pressure. The doctor may further check the sensation of the fingers and the strength of the muscles in your hand. To detect the root cause, the surgeon may recommend a few diagnostic tests. Some of them are- 

  • X-ray
  • Ultrasound
  • Electromyography
  • CT-Scan

Benefits of Endoscopic Carpal Tunnel Surgery over Open Carpal Tunnel Surgery

The following are a few significant factors that showcase the benefits of endoscopic carpal tunnel surgery over open-cut carpal tunnel surgery- 

  • Blood loss- The incision made in endoscopic surgery is smaller, which results in minimal bleeding compared to open-cut surgery.  
  • Recovery period- After endoscopic carpal tunnel release, recovery is quicker than open surgery.
  • Incision size- The size of an open carpal tunnel surgery incision is usually 3 to 4 cm. Endoscopic carpal tunnel incision size is approximately 1 cm, which is much smaller and decreases the scarring after the surgery.
  • Risks and complications- The risk of infection, hand pain, and scar tenderness is higher following an open surgery than endoscopic surgery.

Why does a Person Require Carpal Tunnel Syndrome Surgery?

The following are certain situations for which a person may require carpal tunnel syndrome- 

  • The nonsurgical interventions for carpal tunnel syndrome fail to provide relief from the pain.
  • The muscles of the hands or wrists are weak and getting smaller because of the severe pinching of the median nerve. 
  • The symptoms of carpal tunnel syndrome have lasted 6 months or longer with no relief.
  • The doctor performs an electromyography test of the median nerve and determines that you have carpal tunnel syndrome.

Aftercare for Carpal Tunnel Syndrome Surgery

Post carpal tunnel syndrome surgery, most patients are discharged on the same day. During discharge, patients are also provided with instructions for smoother and faster recovery. Some of the instructions may include the following- 

  • Physiotherapy sessions for restoration of normal function and to regain muscle strength. 
  • Regular cleaning of the surgical site to avoid infection
  • Use of ice packs to reduce swelling or redness post-surgery 
  • Wearing a splint for the suggested time to support recovery post-surgery
  • Minimal exercise to improve movement

Physiotherapy Post Carpal Tunnel Syndrome Surgery

After carpal tunnel release surgery, the recovery will take much longer if the patient does not follow proper rehabilitation and physiotherapy. Physiotherapy helps avoid the build-up of scar tissue in the operated region and opens up the tunnel in the wrist to allow proper wrist function. It also helps regain a complete range of motion for the wrist. In addition to physiotherapy, patients should also wear assistive devices such as thumb splints to encourage recovery.

Common exercises to follow after carpal tunnel surgery are:

Finger tip touching: Hold your hand, palm side up, and touch your thumb with each fingertip in both directions to complete a full cycle. Perform this exercise 3 to 5 times.

Wrist flexion and stretch: Extend your arm with the wrist flexed at a 90 degree angle. Pull the wrist back by the other hand. Hold this position for 10-30 seconds, 5-6 times for each hand.

Tendon gliding:  Hold your hand straight up and bend your fingers at a 90 degree angle towards the first knuckle while keeping the fingers together. Then, bend them towards the second knuckle, then form a fist. Then open the hand and repeat the action 5-10 times.

Risks & Complications Associated with Carpal Tunnel Syndrome Surgery

The following are a few risks and complications involved in carpal tunnel syndrome surgery- 

  • Infections around the surgical site
  • Nerve damage 
  • Loss of sensation
  • Failure to treat the symptom
  • Excessive swelling 
  • Hemorrhage
  • Fracture to the nearby bone
  • Internal bleeding
  • Inflammation at the surgical site
  • Not able to perform a full range of motion

When can I resume work post carpal tunnel syndrome surgery?

If carpal tunnel syndrome surgery, also known as carpal tunnel release, is performed on the dominant hand, the patient can resume work within 6-8 weeks. However, if the surgery is performed on a non-dominant hand and they don't need to perform the less repeated motion, the patient can go back to work within 2-3 weeks. This average duration may also differ from one patient to another, depending on the severity of the condition and the type of profession you are into. 

Movement Restrictions Post Carpal Tunnel Syndrome Surgery

After carpal tunnel syndrome surgery, usually, there are no restrictions on activities. However, if you are doing activities that put excessive pressure on your operated wrist, you may feel pain for several days or weeks. Therefore, an orthopedic surgeon suggests a few guidelines that include restrictions or some activities to avoid complications post carpal tunnel syndrome surgery. 

Signs that can Indicate the Requirement of Carpal Tunnel Syndrome Treatment

The following are a few signs that can indicate carpal tunnel syndrome treatment- 

  • Loss of sensation in the fingers
  • Not able to do proper movements in fingers
  • Weak grip 
  • Excessive pain in the affected hand extending upto the elbow joint
  • Not able to hold things up for long periods
  • Numbness or sensation of tingling in the palm, thumb, and fingers. 

Consult an Orthopedic Surgeon for Carpal Tunnel Surgery

Consult an orthopedic doctor or an occupational therapist as soon as you exhibit the symptoms. The symptoms of carpal tunnel syndrome worsen at night, so if you are experiencing nocturnal wrist pain, it may be a sign of carpal tunnel syndrome. The condition can be managed if caught in time via medicines and physiotherapy. However, surgery is the only treatment option for severe cases.

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