Carpal Tunnel Release is one of the commonest hand surgery procedures. Patients with numbness of one or both hands; diagnosed as having carpal tunnel syndrome – when the pressure on the median nerve at the wrist becomes great enough to compress the nerve – may be offered carpal tunnel release surgery if they continue to be symptomatic despite medical treatment. The procedure relieves the damaging effect of persistent high pressure on the nerve, giving the patient relief from pain and numbness.
Carpal tunnel release is also indicated when patients present with severe symptoms during the initial consultation, such as decreased feeling in the fingers and atrophied muscles of the thumb. At this stage, there is already nerve damage and the aim of the surgery is to prevent further nerve injury and deterioration.
In severe swelling associated with wrist fractures, the rapid loss of nerve function necessitates emergency carpal tunnel release to decompress the median nerve. Finally, if there is a space-occupying growth in the carpal tunnel, carpal tunnel release will also be required, but it is often combined with surgery to remove the lesion in question.
Carpal tunnel release divides the thick and unyielding flexor retinaculum; a broad band of fibrous tissue that stretches across the wrist bones to enclose the median nerve in a tunnel. A safe and reliable technique in use since 1924, it can usually be performed as an outpatient surgical procedure under regional anaesthesia.
There are two main types of carpal tunnel release: open and endoscopic. In the open procedure, a cut is made in the middle of the palm overlying the flexor retinaculum, exposing the whole median nerve as it passes through the carpal tunnel. This allows the surgeon to check for any abnormalities and allows for the excision of growth or swelling.
A common problem that patients develop with the open procedure is a sensitive scar that is painful when pressure is applied to the middle of the palm. The endoscopic procedure was developed precisely to avoid this problem. Rather than make the incision in the middle of the palm, a much smaller cut is made at the wrist crease or further towards the finger; away from the contact area of the palm. Using an endoscopic cutting device, the retinaculum is then completely freed and released under direct vision from the incision.
The primary benefit of endoscopic surgery is a significantly shortened functional recovery in the early postoperative period. There is also less pain and scarring as the incision is smaller. However endoscopic surgery will cost more due to the additional hardware needed for the surgery and not everyone may be suitable for endoscopic surgery. Your doctor will help you make an informed decision by explaining your surgical options and the risks involved with both the open and endoscopic procedures.
Relief from the symptoms of carpal tunnel syndrome is often quick and dramatic after the procedure. This is however mitigated by some pain over the fresh surgery site, and the patient may feel that the strength of the hand has been significantly decreased. However, both should goaway with time.