Surgical Solution for Carpal Tunnel Syndrome
Whether you have just started to explore the possibilities prior to carpal tunnel syndrome or your general practitioner recommended this page, you found the right place. We help you to receive thorough information on the possible solution of your CTS.
Carpal tunnel release is a surgical intervention performed for treating the painful numbness of the wrist called the carpal tunnel syndrome.
Anatomy of the Wrist
Median nerve of the hand as well as flexor tendons pass over a special zone called the carpal tunnel. This tunnel is created by the U-shaped carpal bones and the transverse carpal ligament. In case this tunnel became narrowed down anatomical structures in the tunnel put the median nerve under pressure. This change can induce pain, numbness and tingling sensation in the hand. If remained untreated it could lead to clumsiness and loss of functioning of the hand. Symptoms usually develop slowly and gradually, but become more severe in the course of time. The zone of the thumb is especially involved in this process.
Most Common Causes of Wrist Pain
Carpal tunnel syndrome can be developed by:
- Strains at the workplace
- Repetitive movements (e.g. playing an instrument)
- Exposure to vibration
- Injury
- Wrist fracture
Furthermore, it can be connected to pregnancy, diabetes, thyroid disorder and rheumatoid arthritis.
The Surgical Process
During the carpal tunnel release operation the surgeon cuts through transverse carpal ligament pushing and narrowing carpal tunnel. By this intervention larger space is created for the central nerve of the hand as well as flexor tendons. The surgery reduces painful numbness and improves the movement functions and dexterity of the operated hand.
Patient Eligibility
During the examination your treating physician overviews data of antecedence related to the disease and implements a thorough physical assessment.
Examining the electrical stimulation of the nerve is necessary in all cases. Even if the pain and other symptoms are severe other possibilities can be recommended beside operation. These may include:
- Wrist support
- Medication
- Injections
- Physiotherapy
Surgery is to be considered if symptoms still remain after these treatments and the electric stimulation test confirms the presence of carpal tunnel syndrome.
Articulated pain and numbness resulting significant reduction in life quality can facilitate patients’ decision on undergoing the operation.
Those patients opt for surgery usually declare that their symptoms inhibit them during everyday activities, work, sports, hobbies or cooking. Since these symptoms intensify during the night sleeping is disturbed, too.
Operation is the next possibility in case all non-invasive treatments proved to be inefficient.
PLAN YOUR SURGERY AHEAD: THINGS TO BEFORE AND AFTER
Complete description of carpal tunnel surgery including preparations and rehabilitation.
Our common goal is to efficiently implement the surgery. We now provide you with a list of some fundamental factors that contribute to the success of the operation and reduce the possibility of complications.
Step 1
Be Healthy Before the Operation!
Blood sugar level
You shall complete a blood glucose test during the preparational phase. In case you are diabetic, please, measure your blood sugar level regularly during the weeks prior to the operation. Adequate glycaemic control significantly reduces the risk of wound infection. We carry out a blood sugar test right before the surgery. In case the value is above 6.7 mmol/l the operation is probably postponed.
Smoking
We ask you not to smoke in the last month before the surgery. Smoking deteriorates microcirculation that can lead to wound healing issues. It is in your own interest to quit smoking in this period. Following the operation you are not allowed to smoke for at least 24 hours.
Eating
Good nutrition is of key importance. Eat a lot of fresh and colourful fruits and vegetables as well as sufficient amount of protein (meat, egg and fish). Reduce the consumption of sugar and carbohydrates (e.g. white flour, pasta, sweet treats, soda pops etc.). Balanced diet contributes to wound healing and regeneration. Please make sure you drink enough water. Do not start any weight loss diet, since insufficient food consumption impedes wound healing.
Skin
Take good care of your hand, use cremes to soften the skin, check your nails and avoid getting small wounds (e.g. scratches inflicted by pet animals).
Plan Your Surgery Ahead: Things to Before and After
Following the operation you shall rest your hand for a few days. That is why it is important to prepare for this period.
- Use your healthy hand for every activity during the last couple of days prior to the carpal tunnel surgery.
- Since the wound and the bandage cannot be contacted with water before suture removal you should try to wash yourself using rubber gloves.
- Complete household tasks such as cleaning, shopping and cooking in order to avoid doing these with newly operated hand.
- You cannot drive after the surgery (for further information see Frequently Asked Questions) and, due to the risk of injury, using public transport is not recommended, either. Please, organise your way of getting home.
- If you have a preferred pain-killing medicine, it is advisable to have it available in your home.
Your active cooperation largely contributes to fast and eventless recovery.
Step 2
The First Phase: The Last Visit in the Doctor’s Office
You and your operating physician discuss all the following topics:
- Pre-surgical medical records
- Medication with particular attention paid to drug intolerance and taking coagulants
- The necessity of a complementary nerve ultrasound examination
- In case any kind of accompanying examinations or consultations took place (e.g. with a cardiologist) results are talked over as well as (if necessary) the application of coagulants and the possibilities of using any substitute medicines
- Following the detailed discussion surgical consent is given which is an indispensable prerequisite of the operation
Step 3
The Day of the Operatio
Upon arrival nurses help you settle in a room where you and your companion can wait comfortably. We ask you to take all your jewellery off before the operation.
Your blood pressure is checked.
You shall wash your hand and forearm thoroughly with soap and water in the bathroom.
Our OR nurse transports you to the operating theatre and inserts a cuff similar to that of a blood pressure monitor to your arm. This cuff puts pressure to your arm minimising the blood loss during the surgery.
At that point the process is divided into two branches depending on whether you chose sleeping through the operation or receiving local anaesthesia.
In case the surgery is performed under local anaesthesia your operating physician gives you the analgesic injection.
If the surgery is completed while you sleep the anaesthetist and the assistant perform anaesthesia.
Step 4
Discharge
Patients undergoing carpal tunnel release can go home in the day of the surgery.
Before letting you go home stability of vital signs (blood pressure, heartrate, breathing and body temperature) are, of course, checked.
It is recommended to keep your arm in a sling until the first check-up.
We provide patients with a painkiller prescription, although it is advisable to buy your favourite analgesic product before the operation.
You receive your hospital discharge report in which we indicate what you should be aware in the post-surgical period and when your first check-up is due.
Step 5
A Few Tips and Tricks After Going Home
One or two days after the operation, following the first check-up examination you can use your hand to grab lighter objects and use cutlery.
Eight to ten days after the surgery, when sutures have been removed water can touch the wound. There’s no need of using rubber gloves any more.
In later stages Calendula (marigold) cream and scar softening ultrasound or laser treatment is recommended (from wrist to the middle of the palm).
Patients can usually perform hard physical work (e.g. tree pruning) without any pain or other symptom approximately two months after the surgery.
Frequently Asked Questions
No. Based on clinical and electronystagmography (ENG) examinations, the time passed since the disease’s development and existing concomitant illnesses your physician decides on applying conservative treatments or performing the surgery.
No strong pain is felt. Moderate discomfort can be experienced during the first one or two days that can be controlled by analgesic pills. People usually aware of their pain tolerance level and should ask for mild, medium or strong painkillers from their physician. After the first few days pain is reduced to a minimal level or disappear completely. This might delude many patients who then increase the use of their hand. However, it is important to keep the instructions regarding rest periods.
In the day of the surgery, regardless whether local or deep anaesthesia was applied. We recommend staying one night in the hospital for only those patients who were sleeping during the surgery and live really far away.
The first one is usually due one or two days after the surgery, since a small blood drain must be taken out from the operation site. Suture removal is done 7 to 14 days following the surgery (depending on the age and concomitant illnesses of the patient).
The question is: for what? We recommend not letting your arm hang freely but use a sling instead. Nevertheless, you can grab cutlery and other small objects.
Two or three days after the surgery in case the left hand was operated or the car has automatic transmission. If the surgery was performed on the right hand and your car has a traditional gear shift we suggest driving only two or three days following suture removal (sudden use of gear shift can be painful, therefore it can cause accidents).
It depends on your job. In case you give oral instructions all day long, you can do it on the next day, of course.
It is also important which hand was operated. If it is the dominant hand (the one you write with) then the amount of writing determines the resting period (e.g. 10 to 20 signature can be completed one or two days after the surgery).
You can use the computer without pain around the time of suture removal.
Light physical work can be done after three to four weeks, while hard physical work is recommended after six to eight weeks.
Both methods have advantages and disadvantages – it is useful to discuss them with your physician. The recommendation regarding the type of anaesthesia applied is based on the following factors:
- Age
- Gender
- Muscle mass
- Body weight
- Pain tolerance level of the patient
Of course, we negotiate with the patient in each case and accept their requests. On the other hand, we reserve the right not to perform the surgery in case the patients would compromise, with their decision, their own safety or the successful implementation of the surgery.
It may happen, although very rarely. It is experienced mostly in those cases where following former carpal tunnel release interventions patients use crutch or walking stick because of their difficulties in walking.
Yes, it happens more frequently. In many cases it can develop in both hands simultaneously with different severity. It is not possible to operate two hands at the same time. A few months must pass between the two surgeries.
Yes, it happens more frequently. In many cases it can develop in both hands simultaneously with different severity. It is not possible to operate two hands at the same time. A few months must pass between the two surgeries.
In this case muscles of the thumb may become seriously damaged and the dexterity of the hand deteriorates significantly. The nerve itself can suffer irreparable lesion due to an elongated and severe version of carpal syndrome.
No. It is very likely that the tunnel disease will completely disappear after childbirth.
Unfortunately, we cannot give a 100% guarantee, since it largely depends on individual parameters. As an average, numbness disappears at around 95 to 97% of all cases after releasing the tunnel and the nerve hiding in it.
Have you had any further questions regarding carpal tunnel syndrome, please write to us!
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