Carpal tunnel release

Carpal tunnel release is an operation to correct carpal tunnel syndrome. The carpal tunnel is formed on three sides by the carpal bones of the wrist. The top of the tunnel is a ligament. It is on the palm side of the wrist. Tendons from the muscles in the forearm pass through the carpal tunnel to the ends of the fingers and thumb. A nerve also passes through the carpal tunnel. The tendons swell up when overworked or irritated and push the nerve against the ligament. When carpal tunnel release is done, the ligament is cut, so it no longer presses against the nerve.

The procedure may be necessary if the muscles of the hand are losing strength, or if the symptoms of carpal tunnel syndrome:

• are severe
• interfere with the activities of daily living or
• cannot be relieved by splinting, taking medicines or a shot of cortisone into the carpal tunnel

With carpel tunnel release surgery, the ligament is cut the whole length. This releases the pressure on the nerve. There are several ways that carpal tunnel release can be done. The most common are open surgery and endoscopic surgery. With open surgery, an incision is made in the wrist to expose and cut the ligament. With endoscopic surgery, a small thin, lighted instrument called an endoscope is put into a smaller cut. Another special instrument is put in through another small cut and is used to cut the ligament.

If the carpal tunnel syndrome developed after an injury, such as a wrist fracture, open surgery may be best to remove scar tissue. Endoscopic surgery is usually for patients whose carpal tunnel syndrome is caused by overuse of the hand and wrist. Both of these procedures should be discussed with the surgeon. The surgeon can recommend which is the best surgery for each person. Both of these surgeries are usually done as outpatient procedures. The person can go home the same day of the surgery.

The surgeon will also discuss and recommend the type of anesthesia to be used. Local anesthesia is similar to what a dentist uses. It is used to make the surgery area numb and free of pain. The person will be awake during the surgery. With general anesthesia, the person will be asleep, feel no pain, and have no memory of the surgery.

Before surgery, the surgeon may order some laboratory tests and x- rays. Special instructions will be given on how to prepare for the surgery. These may include not eating or drinking anything including water for several hours before the surgery.

After surgery, the arm and hand will be bandaged. A nurse in the recovery room will monitor the person, until they are ready to go home. Home care instructions may include keeping the hand raised above the heart for several days. This helps to keep the swelling to a minimum. The hand should be kept out of water for several days, or until cleared by the provider.

After the stitches are taken out, the hand can be used for most activities. The hand should not be used for heavy lifting for 4 to 6 weeks. Occasionally physical therapy may be necessary.

Possible complications may include:

• pain in the hand
• painful scar in the hand
• infection
• loss of feeling in the index finger and thumb
• weakness of the muscles to the thumb

If there are signs of infection, the provider should be called. These symptoms could include:

• pain that gets worse after 24 hours
• swelling and redness of the incision
• foul smelling drainage coming from the incision or
• a fever over 100 degrees Fahrenheit (37.8 degrees Centigrade)

The symptoms of carpal tunnel syndrome may be relieved right after the surgery, or in a short time. Tenderness at the incision site may last until it is completely healed. Numbness may last for a while, especially if the symptoms had been severe.

Last Reviewed 2005

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIL File BONE4241.Rf2 VRS# 4241 Data Version 7.0 Copyright 1999-2000, 2002 McKesson Health Solutions LLC. All rights reserved.