Carpal Tunnel Release Surgeryin Kadapa: Procedure & Recovery

Carpal Tunnel Release Surgery is a procedure to relieve the pain, numbness, and tingling sensation caused by carpal tunnel syndrome. This procedure releases the pressure on the wrist by cutting the fibrous band present inside the wrist. Carpal tunnel (a passageway in the wrist) syndrome (CTS) is a common medical condition affecting your hand due to the compression of your median nerve (a nerve that runs through the carpal tunnel to the hand). The median nerve provides sensation to the palm side of your hand and wrist, and any compression can cause severe pain, numbness, and tingling sensation. If left untreated, it can lead to permanent dysfunction of the hand; hence it is important to diagnose and treat the condition promptly. 

Treatment of Carpal Tunnel Syndrome involves lifestyle changes, wrist splints, and steroid injections. However, when these methods fail, the "Carpal Tunnel Release" procedure is performed. The treatment depends on the severity of the pain and the presence of muscle weakness in your affected hand. Treatment options include:

Non-surgical methods

• Precautionary measures should be taken to avoid any activity or position that may cause overextension of your wrist.
• Wrist splints to hold your hand in a neutral position, especially at night.
• Pain medications to reduce pain and discomfort.
• Anti-inflammatory drugs that help to reduce swelling and inflammation.
• Treatment of underlying medical conditions, such as diabetes ( increased blood sugar levels), or arthritis (inflammation of the joints). 
• Steroid injections to reduce inflammation in your carpal tunnel area. 
• Physical therapy exercises like wrist bending and straightening.

Surgical methods 

• Surgery is recommended when the damage is severe and not treatable through non-surgical methods. 
• The most common surgery that helps treat carpal tunnel syndrome is "Carpal Tunnel Release" surgery. 

Carpal tunnel syndrome is most often caused due to narrowing of the carpal tunnel that increases the pressure on the median nerve. This causes severe pain, numbness, tingling sensation, and muscle weakness. Carpal tunnel release is a surgical procedure that helps relieve the symptoms when other non-surgical methods fail to provide relief.

It is a surgical procedure involving cutting through the ligament around the wrist (transverse carpal ligament) that presses down the carpal tunnel. This facilitates more space for the median nerve to pass through the tunnel, thereby reducing the increased pressure exerted on the nerve. 

The carpal tunnel release surgery is performed through two techniques, that include:

Open carpal tunnel release

• This is a traditional method where the surgeon makes a single large incision to open the wrist and release the pressure. 

Endoscopic carpal tunnel release

• This is a more advanced, minimally invasive procedure that involves 1 to 2 small incisions.
• A special tube-like device that contains a camera is inserted into the wrist to guide the surgeon. 
• Other tiny surgical tools are inserted through other incisions to perform the surgery. 

The carpal tunnel is a narrow passage present in the wrist that contains the median nerve and tendons passing through it. The tunnel is surrounded by the wrist bones on the bottom and the transverse carpal ligament across the top of the wrist. When the nerve is injured, it causes swelling around the carpal tunnel and other related symptoms. 

Stages of Carpal Tunnel Syndrome (CTS) include:

• Stage 1- An early stage of CTS with mild symptoms like occasional pain and weakness.
• Stage 2- A moderate stage with symptoms like tingling and numbness that occur more frequently.
• Stage 3- A severe stage with constant symptoms that cause functional impairment.

Stage 3 carpal tunnel syndrome is usually treated surgically through carpal tunnel release surgery. 

The reasons that your surgeon would recommend a carpal tunnel release surgery may include:

• The doctor confirms the presence of carpal tunnel syndrome through an electromyography test.
• Failure of non-surgical methods to treat carpal tunnel syndrome
• The muscles of the hands and wrist weaken and begin to get smaller due to severe pinching of the median nerve
• The symptoms of carpal tunnel syndrome have lasted for more than 6 months

Consult a neurologist (a doctor specializing in the disorders that affect the brain, spinal cord, and nerves), if you experience any of the symptoms mentioned above. Your doctor will record your medical history to evaluate the signs and your general health to determine the treatment plan that best suits you. 

Keep your doctor informed about the following:

• Other medical conditions include diabetes, arthritis, hypertension (high blood pressure), asthma, or other disorders related to the heart, lungs, or kidneys. 
• Any allergy to latex, anesthesia, or other drugs to prevent any untoward complication during or after the surgery.
• Medications that are being taken such as blood thinners, anti-inflammatory drugs, and other herbal supplements.

The diagnosis of carpal tunnel syndrome can be confirmed through a physical examination of the affected hand, along with a few medical tests. 

• Your doctor will examine your hand for reflexes to rule out other conditions that mimic carpal tunnel syndrome. 
• The wrist will be examined for any swelling, tenderness, deformity, or discoloration.
• Tinel's sign- In this test, your doctor taps over the median nerve at the wrist to check if it produces a tingling sensation in your fingers.
• Phalen's maneuver- Your surgeon will reproduce the symptoms by bending the wrist downwards.
• Nerve conduction velocity test- The test will measure the rate of electrical impulses as they travel down a nerve. In CTS, the nerve impulse slows down.
• Electromyogram (EMG)- This test is performed with a nerve conduction velocity test to detect other conditions that mimic CTS. 
• Blood tests- To evaluate the thyroid hormone, complete blood count, blood sugar, and protein to rule out conditions associated with CTS.
• X-ray of the wrist to check for abnormalities associated with the bones and joints. 

Preparation

• You must discontinue your medications, like blood thinners, anti-inflammatory drugs, etc., 2 weeks before the surgery to prevent the risk of bleeding.
• You must avoid smoking and alcohol 2 to 3 weeks before surgery since they delay wound healing.
• Arrange for someone to drive you back home since you should avoid driving for the initial few weeks after the surgery.

Carpal tunnel release surgery is an outpatient procedure (does not require hospitalization) typically performed under local anesthesia (numbs only the part that has been anesthetized).

1. On the day of the surgery, your vitals (blood pressure, heart rate, pulse, and blood sugar levels) will be checked by your nurse. 
2. Using an antiseptic solution, your nurse will disinfect the surgical site to remove surface contaminants. 
3. Your anesthesiologist will inject local anesthesia around your wrist to numb the area so you do not feel pain. Sometimes general anesthesia (puts you to sleep/ may be necessary for patients with severe pain and soreness. 
4. Your surgeon will perform the carpal tunnel release surgery through the following methods:

Open carpal tunnel release

• Your surgeon will make a 2-inch incision with a scalpel (surgical knife) on your wrist.
• Surgical instruments will cut the transverse carpal ligament and widen the carpal tunnel.
• The procedure takes around 60 minutes.

Endoscopic carpal tunnel release

• In this approach, your surgeon will make two half-inch incisions. One will be on your palm and the other on your wrist. 
• Your surgeon will then insert a thin, flexible, tube-like scope (endoscope) into one of the incisions.
• Tiny surgical instruments will be inserted through the other incision to cut the transverse carpal ligament to expand the tunnel.

5. The procedure will usually take 30 to 45 minutes. 

6. Your surgeon will close the incisions through stitches. 

7. Your hand and wrist will be placed in a splint or bandage to keep you from moving your wrist. 

You are expected to be sent home an hour after the surgery with a protective splint placed. This helps to protect your hand from any injury. 

• Once you are back home, keep your operated hand elevated, especially during sleep. Your splint will be kept in position for 1 to 2 weeks.
• It is normal to have mild pain and swelling that can be easily managed with painkillers and hand elevation. 
• You will begin physical therapy once your splint is removed. This helps strengthen your wrist and improve healing. This includes:
  • Wrist extension and flexion stretch
    • Extend your arm in front and bend your wrist at 90 degrees angle.
    • Using your other hand, gently pull your wrist back with your fingers.
    • Hold for 15 to 30 seconds and repeat 4 to 5 times daily. 
• You may return to your normal routine in 6 to 12 weeks, but complete recovery may take up to a year 

Carpal tunnel release surgery is an effective procedure that releases the pressure built within the carpal tunnel that squeezes the median nerve. It has the following benefits:

Benefits

• Reduces the associated symptoms and improves your quality of life.
• Improves your hand and wrist movements.
• Prevents permanent dysfunctioning of your hand.
• Prevents further median nerve damage.
• The endoscopic approach involves minimal incisions and bleeding with quick recovery. It also facilitates minimal scarring around your wrist. 

Risks

As with any surgical procedure, carpal tunnel release surgery is also associated with a few risks, such as:

• Allergic reactions to anesthesia with symptoms like skin rashes, hives, itching, dizziness, confusion, and breathing difficulties.
• Infection around the incision wound with pus discharge.
• Injury to the median nerve or branch through it.
• Uncontrolled bleeding during the procedure or from the surgical wound.
• Injury to nearby blood vessels.

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