What is carpal tunnel release surgery?
Carpal tunnel release (CTR) is one of the most common surgeries performed and generally has excellent results. Complications are very rare.
The surgery involves cutting the transverse carpal ligament, which is compressing the median nerve. While intentionally cutting a ligament to improve your hand function may seem counterintuitive, long-term outcome studies have shown consistent improvement with minimal downsides.
The surgery is almost always performed in the outpatient setting (i.e. you will go home the same day). Here we will discuss what to expect before, during and after surgery.
How do I prepare for surgery?
Depending on the type of anesthesia used (more on this below), you may be asked to go without food and drink on the day of surgery. This generally means nothing by mouth after midnight prior to your surgery.
If you normally take medications in the morning, ask your surgeon for guidance.
What can I expect on the day of surgery?
Location: CTR can be performed at a hospital, an ambulatory surgical center, and even in the clinic or doctor’s office.
Paperwork: There is often some paperwork to be signed before surgery, the most important of which is the informed consent form. Informed consent is the idea that you and your surgeon have discussed the risks and benefits of surgery, and both the surgeon and the patient agree to move forward with surgery. There may be a separate consent form for anesthesia.
Anesthesia: There is a wide range of options for anesthesia for CTR, including the following:
General anesthesia with a breathing tube
Sedation (sometimes called “twilight,” as is often used for a colonoscopy)
Peripheral nerve block (PNA)
Local anesthesia (usually with lidocaine, similar to what is used for numbing your mouth for dental work)
A combination of the above
There are advantages and disadvantages to all of these options, and your surgeon and/or anesthesiologist will likely discuss these pros and cons either on the day of surgery or during an office visit before surgery.
For general anesthesia and sedation, fasting is required and an IV line will need to be placed prior to surgery. If the surgery is being done with local anesthetic only, no fasting is required, there is typically no need for an IV line, and you will be wide awake throughout the procedure.
A common concern among patients is that they will feel the pain of surgery if they are awake. Rest assured, after the initial injection of lidocaine, you should feel no pain during the procedure. You may feel the surgeon and assistants moving your hand, and you may even feel touch, but the lidocaine is very effective at blocking pain. If by chance you do feel pain, alert your surgeon and they will likely administer more anesthetic medication.
Incision: The incision (the cut) used for CTR typically falls into one of two categories, depending on the technique used. For open CTR, a 1.5-2-inch incision is made in the palm, just beyond the wrist crease, in line with the ring finger. For endoscopic CTR (using a scope), one or two 0.5-inch incisions are made where the forearm meets the wrist and/or in the palm. There are pros and cons to each technique, which you can discuss with your surgeon. On rare occasions, a much longer incision is required, referred to as an extended CTR. This incision begins where the forearm meets the wrist crease, often has a zig-zag course, and extends to the mid-palm, with a total length of 3-4 inches.
Stitches and bandage: Surgery lasts anywhere from 15-30 minutes. Once the ligament is cut, the skin incision is closed with stitches. The stitches may be absorbable or non-absorbable. Absorbable stitches will dissolve on their own, while non-absorbable stitches will need to be removed around 7-14 days after surgery. A bandage will be placed, which usually consists of an elastic bandage (e.g., Ace, Coban, or Band-Aid). On rare occasions, you may be placed in a splint to prevent wrist motion.
What should I expect after surgery?
Activities after surgery: With general anesthesia and sedation, you will be groggy after surgery and will require a ride home. You should plan on resting for the remainder of the day. Regardless of the anesthesia type, you should plan on only light activities for the rest of the day (texting, typing, eating, reading, TV). As anesthesia wears off, you will start to feel pins and needles in your hand and fingers. Numbness from the surgery can last anywhere from a few hours to 1 day.
Restrictions and wound care: Each surgeon will have their own specific after-care guidelines. As a general rule, it is safe to move your fingers, but avoid lifting anything heavier than a cell phone (movement is safe, heavy lifting is not). For the next few days, keep your hand elevated above your heart as much as possible (while traveling in the car, sitting on the couch, and while sleeping). Keep your bandage clean and dry until your surgeon tells you it is safe to remove it. For the first few days, it may be convenient to have disposable rubber or vinyl gloves available, especially for using the bathroom, as hand washing may be difficult with the bandage.
Pain control: There will be some pain after surgery. There are 2 keys to good pain control: strict elevation and over-the-counter medications. Talk to your surgeon about which pain medications are best for you. A common prescription is ibuprofen 800 mg taken 3 times a day and acetaminophen 1000 mg taken 3 times per day (these can be taken at the same time or staggered, such that you are taking medication every 4 hours). It is safe to apply an ice pack to the wrist and hand—just make sure to keep the bandage dry.
Relief of symptoms: Some people feel immediate relief after surgery and awake the next morning with a hand that no longer falls asleep. Sometimes the improvement takes days to weeks—each patient is different. It is normal to have soreness in the palm around the incision site for weeks after surgery. This soreness typically resolves around 6 weeks but can occasionally last 3 months. You can expect to return to full activities, including weight lifting and pushups, between 6 weeks and 3 months after surgery. The goal of surgery is the “forgotten hand”—the idea that you will wake up one morning and think to yourself, “I haven’t thought about my hand in a week!” This typically happens 3-6 months after surgery.
Follow-up appointment: Expect to see your surgeon or a hand/occupational therapist 1-2 weeks after surgery. They will remove stitches (if non-absorbable), evaluate the wound for any signs of infection, and give you instructions on moving your fingers, hand, and wrist.
How much time should I take off from work?
Each patient is different. For heavy labor, it may be wise to wait 4-6 weeks before returning. For strictly light office work, some patients return the next day. Many patients are able to return to their job on the Monday following surgery. Discuss this with your surgeon during your office visit before surgery. If you have paperwork from your employer that needs to be filled out, plan to do this before or after surgery, but not on the day of surgery.
Summary
Carpal tunnel release is an outpatient surgery with excellent results. The surgery can be done with general or local anesthesia. Both open and endoscopic techniques are used. Pain control after surgery is with elevation and over-the-counter medications. Depending on your work, you may return in a few days or weeks.
Article Reference: ASSH Hand Blog
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