Carpal Tunnel Syndrome Surgery
Carpal Tunnel Release
Carpal tunnel syndrome is a painful hand condition accompanied by numbness, most commonly occurring in the wrist area. This is known as Carpal or carpal tunnel syndrome. Its development is significantly influenced by the regular, monotonous overuse of the fingers and wrist, as well as hormonal changes. For this reason, it is particularly prevalent among middle-aged women. Carpal tunnel syndrome surgery is the most effective solution for pain relief.
Development of Carpal Tunnel Syndrome in the Wrist Area
In the wrist joint area, the hand’s median nerve, along with the surrounding muscles, tendons, vessels, and bony structures, form the region we call the carpal tunnel.
This tunnel is formed by the U-shaped carpal bones and the transverse carpal ligament. When these nerves become compressed and the tunnel narrows, numbness, and later pain, occur in the hand.
The development of carpal tunnel syndrome can be promoted by occupations involving significant wrist and elbow strain, strenuous conditions, as well as diabetes, injuries, and temporarily, pregnancy. Carpal tunnel syndrome occurs more frequently in the dominant hand, but can sometimes affect both hands.
Dr. György Kocsis PhD
Orthopedic-Traumatologist, Chief Hand Surgeon, University Assistant Professor, Wrist, Elbow, and Shoulder Surgeon, Upper Extremity Specialist
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Symptoms of Carpal Tunnel Syndrome
In the initial stage of carpal tunnel syndrome, unpleasant tingling and numbness first appear. The symptoms are typically felt in the first three fingers of the hand, not affecting the little finger and ring finger. The unpleasant tingling, numb sensation occurs in the fingers and the thumb side of the palm. The cause of the complaint is that due to tendon swelling, less space remains for the median nerve in the narrow carpal tunnel. Thus, the median nerve becomes compressed, and the surrounding area begins to feel numb.
Initially, symptoms only appear at night, as the tendons do not move at night, causing them to swell more in the tunnel and further compress the median nerve. A common consequence of this is sleep disturbance, but over time, numbness also appears during the day.
Without appropriate treatment, severe, burning pain can develop in the wrist area and fingers, which can become constant over time and then radiate into the entire arm. The grip of the fingers and palm weakens, and atrophy of the palm muscles and the thenar eminence begins, leading to clumsiness of the hand. Along with this, the fine motor skills of the thumb, index, and middle fingers also deteriorate. The longer treatment is delayed, the more damage occurs to the nerves, muscles, tendons, and soft tissues alike.
Diagnosis of Carpal Tunnel Syndrome
With the described symptoms, it is advisable to consult a hand surgeon, who will clarify the presence and stage of carpal tunnel syndrome with targeted examinations. The first element of the hand surgery examination is the anamnesis, where the patient provides a detailed account of their symptoms. The hand specialist assists this with targeted questions. This is followed by a physical examination, where the possibility of carpal tunnel syndrome arises.
For an accurate diagnosis, an electroneurography (ENG) examination is necessary, and occasionally the specialist may recommend X-ray or ultrasound examination of the affected area. The electroneurography examination provides an image of the condition of the wrist nerves, thus indicating the stage of the carpal tunnel disease. Based on this, the specialist establishes the appropriate treatment plan.
Treatment of carpal tunnel syndrome
In the initial stage of the syndrome, the hand surgeon may recommend various conservative (non-surgical) treatments. Most commonly, wrist immobilization, rest, physiotherapy, and possibly physical therapy treatment. In moderately advanced stages, steroid injection is considered. If conservative treatment does not yield results, or if the diagnosis is made in an advanced stage of the disease, surgical release of the nerves is recommended.
Carpal Tunnel Syndrome Surgery
The surgical solution for carpal tunnel syndrome is considered during the hand surgery examination. Based on the precise diagnosis, the specialist informs the patient about the possible treatment methods, their expected effectiveness, and potential risks. The patient always decides on the surgery.
Preparing for Surgery
Before the surgery, take extra care of your affected hand and pay attention to a healthy diet and high fluid intake. If possible, avoid smoking. Health preparations help faster wound healing, reduce the risk of complications, thereby increasing the success of the surgery.
Before the intervention, a laboratory test including blood sugar level measurement is necessary, as well as a consultation with an anesthesiologist.
Procedure of Carpal Tunnel Syndrome Surgery
Carpal tunnel syndrome surgery is performed as a day surgery procedure. The operation can be performed under local anesthesia or general anesthesia; the specialist always makes a recommendation regarding this.
During carpal tunnel syndrome surgery, the hand surgeon cuts the transverse carpal ligament, thereby releasing the narrowed carpal tunnel in the wrist. This provides more space for the median nerve of the hand and the flexor tendons, and eliminates the developed pressure.
During the surgery, if necessary, the inflamed tissue proliferation surrounding the tendons is also removed. Finally, the surgical wound is carefully stitched with a few sutures.
The surgery performed by a specialist hand surgeon takes approximately 20 minutes.
Recovery Time After Carpal Tunnel Syndrome Surgery
The first follow-up examination after surgery is required after 1-2 days, during which the specialist removes the drain from the operated hand.
Suture removal is due 7-14 days after surgery, after which physiotherapy and ultrasound scar treatment can be started as recommended by the specialist.
If the carpal tunnel disease caused impaired hand movement functions, occupational therapy sessions are recommended after surgery for complete recovery.
During rehabilitation, it is recommended to take a larger amount of B vitamins, which promotes nerve regeneration. The total recovery time is approximately two months.
Why is Carpal Tunnel Syndrome Surgery Important?
Many people ignore the unpleasant nocturnal tingling and numbness in the hand in the early stages. However, carpal tunnel syndrome is characterized by symptoms that do not decrease over time but rather intensify and expand. Thus, without appropriate treatment, nighttime symptoms are accompanied by pain and also appear during the day with increasing intensity. In the long term, carpal tunnel syndrome has a significant negative impact on the quality and quantity of nighttime rest, daytime activities, work performance, and other daily routines. Delaying treatment can lead to atrophy of muscles, nerves, and tendons, which can also cause loss of function in the hand and fingers. The risk of surgical intervention is much lower than the negative impact of the consequences of carpal tunnel syndrome on quality of life.
Our Hand Surgery Specialists
Dr. György Kocsis PhD
Orthopedic-Traumatologist, Chief Hand Surgeon, University Assistant Professor, Wrist, Elbow, and Shoulder Surgeon, Upper Extremity Specialist
Dr. János Bartha
Chief Orthopedic-Traumatologist, Robotic Surgeon
Dr. Tamás Hábel
Traumatologist, Hand Surgeon
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