Definition & Overview

Carpal tunnel release is a surgical procedure to alleviate the symptoms of carpal tunnel syndrome, a condition characterised by pain and weakness in the hand due to the pressure exerted on the median nerve located in the wrist.

The median nerve is responsible for the innervation to most of the muscles of the hand, allowing movement and touch perception. It goes through the carpal tunnel in the wrist, a narrow passage with a thick ligament on its uppermost part. Around the median nerve is the synovium, a connective tissue that provides lubrication and assists in the flexing and movement of fingers. When the synovium swells, it puts pressure within the carpal tunnel and on the median nerve.

This procedure is also known as median nerve decompression or carpal tunnel decompression. It is good to note, though, that there is no known cure for carpal tunnel syndrome and this procedure only helps to provide long-term relief from debilitating pain and soreness.

Carpal tunnel syndrome is hereditary and if some of the family members suffer from it, a long-term treatment would have to be considered. It is also more evident among the elderly and those who have diabetes, arthritis, and thyroid hormone imbalances.

Who Should Undergo and Expected Results

Carpal tunnel release is advised for those suffering from carpal tunnel syndrome, with symptoms of numbness, pain, tingling, and feeling akin to electrical shock travelling to the tips of the fingers. This procedure is especially indicated for cases wherein the patient has already tried alternative treatments and remedies such as wearing a splint or brace at night, administering steroids, or ingesting pain medications to relieve the pain. If their condition can no longer be alleviated, the patient may consider this procedure to restore hand function and mobility without pain.

Following surgery, the affected hand must be kept elevated, preferably above heart level. Patients are also asked to move their fingers often to reduce stiffness and swelling. Pain medication is administered and soreness can be felt for a period of time following the procedure. Some patients are asked to wear a wrist brace for several weeks. Carpal tunnel release has a high satisfaction rating with patients able to resume their daily activities without any pain or discomfort.

How is the Procedure Performed?

Carpal tunnel release is a simple procedure, often done in an outpatient setting. The physician administers local anaesthesia and makes an incision in the palm of the affected hand. The carpal ligament traversing the roof of the tunnel is then cut and divided. This helps to relieve the pressure exerted on the nerve and allow space for muscle movement underneath. If there is a need, the tissue around the median nerve is also removed. The incision is then closed using sutures.

Some physicians these days use endoscopic method (minimally invasive technique) for this procedure. This involves making one or two small incisions in the skin and inserting specialised surgical tools and a tiny camera to provide visual guidance. The carpal ligament is cut without making an extensive incision through the underlying subcutaneous tissue.

Another technique recently developed is the thread carpal tunnel release. Using a surgical needle, a piece of thread is inserted under the skin and, with the use of ultrasound for imaging, cuts the transverse carpal ligament in a sawing motion. The needle exits in the wrist area, effectively eliminating the need to make any incisions on the skin.

Possible Risks and Complications

Although very straightforward and relatively safe, carpal tunnel release comes with a number of risks and possible complications, including:

  • Adverse reaction to local anaesthesia
  • Bleeding in the surgical site
  • Pain and tenderness in the affected area – These are common but should subside after a couple of days.
  • Infection of the surgical site
  • Weakness - Because the transverse carpal ligament was cut, some patients may experience weakness and even inability to pinch or grip an object. This condition is also expected to resolve itself after some time, though the patient may need to undergo some form of physical therapy to regain muscle strength.
  • Damage to the median nerve - This is a rare occurrence and could lead to decreased functionality of the hand and fingers.
  • Recurrence - Because there is no ultimate cure for carpal tunnel syndrome, there is still the possibility of recurrence, which would require additional surgery or treatment.

    References:

  • Ashworth NL (2014). Carpal tunnel. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1114/overview.html.

  • Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).

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