Carpal tunnel surgery, also medically referred to as carpal tunnel release (CTR) and carpal tunnel decompression surgery, constitutes surgeries in which the transverse carpal ligament, found in the wrist, is divided. This surgery is the standard course of treatment for patients that have Carpal Tunnel Syndrome. Carpal tunnel syndrome is defined as a condition in which the median nerve in the wrist experiences excessive pressure. This nerve in the wrist is responsible for feeling and movement of parts of the hand. A fairly serious condition, Carpal tunnel syndrome often leads to patients experiencing numbness, tingling, weakness, or muscle damage in the hand and fingers.
Causes of Carpal Tunnel Syndrome
The area of the wrist where the nerve gains entrance into the hand is referred to as Carpal tunnel. The tunnel is naturally narrow. Any swelling of this tunnel can pinch the nerve and cause pain, numbness, tingling or weakness. This forms the basis for developing carpal tunnel syndrome. The more common causes of Carpal Tunnel Syndrome include the following:
- Consuming of excess alcohol
- Bone fractures and arthritis of the wrist
- Developing Cyst or tumor of the wrist
- Presence of infections
- The effects of obesity
- When the body retains extra fluids during pregnancy or menopause
- The effects of Rheumatoid arthritis
- Workers who use vibratory equipment on a daily basis
Symptoms of Carpal Tunnel Syndrome
The signs of Carpal Tunnel syndrome include the following:
- The clumsiness of the hand when holding objects.
- Experiencing numbness or tingling in the thumb and next two or three fingers of one or both hands.
- Experiencing numbness or tingling in the palm.
- Experiencing pain that extends to the elbow.
- Experiencing pain in the wrist or hand in one or both hands.
- Experiencing problems with fine finger movements (coordination) in one or both hands
- Deterioration of the muscle under the thumb (in advanced or long-term cases)
- Weak grip or difficulty carrying bags (a common complaint)
The physician may perform a physical examination of the affected hand. This examination may reveal one or more of the following:
- Numbness in the palm, thumb, index finger, middle finger, and thumb side of the ring finger of the affected hand.
- A weakened hand grip
- Tapping over the median nerve, resulting in pain emanating the wrist to the hand. This is a confirmation of Tinel sign
- Bending the wrist forward all the way and holding for 60 seconds. Carpal syndrome exists when the patient experiences numbness or tingling sensation.
The doctor may also call for tests such as wrists x-rays ( to rule out other problems like arthritis), Electromyography as well as Nerve Conduction velocity ( to determine the speed at which electrical signals move through a nerve).
The basic aim of a Carpal Tunnel Release Surgery is to create more space for nerves and tendons. To achieve this aim, the surgeon cuts through the carpal ligament. The surgery is performed in the following steps:
- To begin the patient receives numbing medicine so that no pain is felt during the surgical process. Often the patients are aware of the activities going on around him/her, but he/she experiences no pain.
- A small surgical cut is made in the palm of the patient’s hand near the wrist.
- Next, the ligament that covers the carpal tunnel is cut. This eases the pressure on the median nerve.
- Sometimes, tissue around the nerve is removed as well.
- The skin and tissue underneath the skin of the wrist are closed with sutures (stitches).
At other times, the surgeon may elect to perform this procedure with the aid of a tiny camera attached to a monitor. This device is inserted into the wrist via a small surgical cut, to view the inside of the wrist. This process is referred to as Endoscopic surgery.
Once the surgery is completed, the patient’s wrist is dressed in a splint or heavy bandages. This is to prevent unnecessary movement and to allow the area heal. After the splint is removed, the patient then undergoes motion exercises or a physical therapy program.