Carpal Tunnel Releases
Carpal Tunnel Syndrome
What causes Carpal Tunnel Syndrome?
Pressure may be put on nerves in the wrist due to inflammation resulting from
repetitive motion, normal wear and tear due to aging, arthritis, fluid retention,
or previous fracture of the wrist which narrows the carpal tunnel.
What are symptoms of Carpal Tunnel Syndrome?
Usual symptoms of Carpal Tunnel Syndrome include pain, numbness, and tingling
in either or both hands and in all or a few fingers. At the onset, symptoms
may be experienced mostly at night. If diagnosis and treatment are delayed,
symptoms tend to get worse: pain increases, grip strength weakens, and you may
drop things. Early treatment may prevent permanent nerve damage and potential
disability.
How is Carpal Tunnel diagnosed?
Your physician will take your history and do a physical examination. Some
questions might include:
- Does your hand primarily bother you at night?
- Do symptoms occur anytime you hold your hand in a static position, such
as working at a computer or driving?
- How do you describe your discomfort in the nature of sensations and the
frequency?
Electro-diagnostic tests may be ordered to determine whether a nerve is being
pinched. These tests may include: nerve conduction studies, electromyography,
and somatosensory evoked potentials. X-rays may be ordered.
What can I do about carpal tunnel syndrome?
Your doctor may order a brace and/or anti-inflammatory medications. If treatment
does not help, surgery may be recommended. Early treatment has the best potential
for a good outcome. Some things you can do to reduce your risk of carpal tunnel
syndrome:
- Make changes in the way you position your hands to maintain a "neutral"
position while working, driving, writing, and so on.
- Minimize repetition-particularly while grasping an object in the same position.
Try to vary even small repetitive movements.
- If you perform repetitive movements with force, make the movements more
slowly in order to allow recovery at the wrist before the next forceful movement.
Use power tools whenever possible.
- Rest or alternate activities. Give your hands and wrists a break occasionally.
- Strengthen hand and arm muscles.
If surgery is needed, how is a Carpal Tunnel Release done?
There are two common ways the Carpal Tunnel Release is done.
- In the open Carpal Tunnel Release, an incision is made down the middle
of your palm.
- In the endoscopic carpal tunnel release, a small incision is made at the
wrist in the crease, and perhaps a small incision at the palm. The transverse
ligament is divided (or released) to open the carpal tunnel and remove the
pressure on the nerve. The procedure takes about 45 minutes.
What will I need to do before surgery?
- Your doctor may want you to have lab tests before surgery. The person who
schedules your surgery will discuss these with you and schedule any tests
needed before surgery.
- Seven days before surgery, you should not use aspirin containing products
or non-steroidal anti-inflammatory medication (NSAID). NSAIDs include aspirin,
ibuprofen, Advil, Motrin, Daypro, and Naprosyn. These medications have been
associated with an increased incidence of blood clots after surgery. There
is a new class of NSAIDS, including Vioxx and Celebrex, that may be taken
until 2 days before surgery. (Stop two days before your surgery day.) This
will be discussed with the doctor who prescribes those medications.
- If you take herbs or alternative prescriptions, please advise your doctor.
Some of these can cause odd interactions with common drugs.
- If your surgery will be in the morning, you will be asked not to eat or
drink anything after midnight the night before surgery. You should not eat
or drink anything 8 hours before surgery. This includes food, water, coffee,
chewing gum, etc. If you take a medication regularly, you may take it with
a small sip of water.
- Wash hands thoroughly several times the day before surgery with antibacterial
soap.
What are the risks of carpal tunnel release?
In addition to the usual risks of any surgery, the potential risks for carpal
tunnel release include:
- Numbness
- Impaired muscle function
- Recurrence or persistence of the condition requiring the operation
- Continued, increased, or different pain.
There are 4 possible outcomes from any surgery:
- Your symptoms or pain may be completely improved.
- Your symptoms or pain may be partially improved.
- Your symptoms or pain may be the same as before surgery.
- Your symptoms or pain may be worse than before surgery.
Your doctor will discuss with you any concerns you may have about the surgery
and recovery.
What can I expect after surgery?
- Naturally, your incision area will be sore; however, if you have any drainage,
pain, redness, swelling, fever, white or pale blue hand or nails, increasing
pain not relieved by medications, or loss of sensation in fingers, please
call the office immediately.
- Do not become alarmed if you experience the same type of pain that you had
before your surgery, or even some new weakness or numbness. This is common
and usually lasts only a short time. The healing process takes time.
- Any time the skin is punctured, infection is a risk. If treated early, infection
is easier to control. Infection is rare, but it can happen. By being aware
of the signs of infection, you can take action quickly if it should happen
to you. If in doubt, call your doctor's nurse. Mention to the switchboard
operator that you have recently had surgery and your call will be handled
immediately.
Be alert for the signs of infection:
- Fever - even one degree
- Heat at the incision
- Increased pain at the incision site
- Drainage that is pus-like in nature
- Redness and swelling at the incision
- Unpleasant odor at the incision
Use your pain medication carefully. Many patients have been on a lot of narcotics
prior to and after surgery. Using them wisely in your post-operative period
will avoid future problems and you will get better pain relief if you do not
have an increased tolerance to them.
Let your pain determine your activity level. If something causes increased
pain, avoid that activity. To keep your hand flexible as it heals, it is best
to begin moving your fingers right after surgery. Certain exercises may be recommended
to help maintain circulation in your hand, improve flexibility, and increase
your strength.
To protect your healing skin and ligament, avoid bending your wrist very far
forward (flexion) or backward (extension).
It is okay to loosen the dressing if it is too tight. The dressing may be
removed on the 4th day after surgery.
Within a day or two after surgery, you can begin to use your hand for light
activities. Your hand will probably be weak at first, but it will get stronger
as you use it. Avoid bumping or hitting the area around the incision(s). In
many cases, you will be able to resume driving when you stop taking prescription
pain medications, usually in about a week.
You may take a shower, but cover the hand and wrist with plastic or some sort
of covering and keep it elevated above the water. It is best not to get the
incision wet until after the sutures are removed and you are told by the doctor
that you can wash it. Do not take a bath as the incision should not be
soaked in water. Do not put oils or ointments on the incision site. Keep
your dressing clean and dry.
For the first several days after your surgery, keep your hand elevated above
the level of your heart to reduce swelling and pain. You may notice that the
palm and the back of your hand are black and blue for a few days-this is normal
and nothing to worry about. If you have discomfort in your wrist or palm, take
your pain medications as directed. An ice pack may also help relieve discomfort.
Follow-up office visits:
Suture removal/incision check and the six week visit:
Sutures will usually be removed within about 10 days. At that time, an appointment
will be made for a 6-week follow-up office visit. You and your doctor can discuss
the results of your surgery.
If your carpal tunnel injury was caused by repetitive strain, you may need
to make some changes in how you use your hands to avoid future problems. With
care, you may regain full use of your hand and remain free from painful symptoms. |
