Carpal Tunnel Syndrome – Open Release Surgery

The Median Nerve travels from the arm through the wrist to the fingers. It passes through a narrow passageway known as the Carpal Tunnel at the wrist's center, bordered below by the wrist bones and above by the Transverse Carpal Ligament, a strong band of tissue connecting the bones. The Carpal Tunnel also houses multiple tendons that facilitate finger bending and flexing.

The Median Nerve provides sensation to the thumb, index finger, middle finger, and half of the ring finger, in addition to sending signals to the Thenar Muscles, which are essential for thumb movement during gripping. When compressed in the Carpal Tunnel, the Median Nerve transmits incorrect signals to the hand and fingers.

Carpal Tunnel Syndrome arises when tissues and tendons in the Carpal Tunnel swell, reducing the space within the tunnel. This can occur alongside medical conditions like hypothyroidism and diabetes, increasing pressure on the Median Nerve and disrupting its function. The exact cause is often unknown.

Conditions such as rheumatoid arthritis, joint dislocations, and fractures can also narrow the tunnel. Hormonal changes may lead to fluid retention and swelling in some women, resulting in Carpal Tunnel Syndrome, particularly during pregnancy, premenstrual syndrome, or menopause.

The hallmark symptoms of Carpal Tunnel Syndrome include pain, numbness, and tingling, predominantly affecting the thumb, index, middle, and half of the ring finger. Individuals may describe the pain as a deep ache or burning sensation, which can radiate into the arms. Weakness and clumsiness in the thumb are common, leading to challenges in grasping objects and potential dropping of items. Symptoms may be aggravated at night, during specific activities, or in colder temperatures.

A healthcare provider can diagnose Carpal Tunnel Syndrome through a physical examination, review of medical history, and discussion of symptoms and activities. During the exam, the wrist and hand will be assessed for sensation and other factors.

Simple tests may be performed to evaluate pressure on the Median Nerve. For the Phalen’s Test, the patient flexes their wrist for 60 seconds; a positive result is indicated by numbness or weakness. For the Tinel’s Sign, the doctor taps on the Median Nerve at the wrist, with a positive result marked by tingling or numbness in the nerve's distribution. Lab tests may be ordered if a related medical condition is suspected, and X-rays may be taken to check for arthritis or fractures.

Nerve conduction studies can be used to assess the Median Nerve’s function and pinpoint the compression site. A common procedure is the Nerve Conduction Velocity (NCV) test, which measures the time taken for nerve impulses to travel. Sticky patches with electrodes will be applied to the skin over the Median Nerve, and while the NCV test may be uncomfortable, the discomfort is temporary.

An Electromyography (EMG) test, often conducted alongside the NCV test, measures electrical impulses in muscles to detect inadequate nerve input. Fine needles are inserted into the muscles controlled by the Median Nerve to evaluate impulse conduction during muscle contractions. The EMG may cause discomfort, and muscle soreness may persist post-test.

Carpal Tunnel Syndrome symptoms can often be managed without surgery. Treatable underlying medical conditions may alleviate symptoms, and some cases respond well to rest and pain relief strategies. A doctor may recommend a splint to support the wrist in a neutral position, especially at night.

Wearing splints during activities that exacerbate symptoms can help position the wrist correctly. Over-the-counter anti-inflammatory medications may also be suggested to reduce pain and swelling. In some cases, corticosteroid injections may be used to relieve symptoms.

Surgical intervention is considered when non-surgical methods are ineffective or if the condition worsens. Various outpatient surgical options are available to alleviate pressure on the Median Nerve, with the physician helping to determine the best approach.

The standard procedure is known as Open Release Surgery, during which a local or regional anesthetic numbs the hand area. The surgeon makes a two to three-inch incision along the palm to access the Transverse Carpal Ligament, cutting it to enlarge the tunnel and relieve pressure on the Median Nerve. The surgery is relatively quick, typically lasting around fifteen minutes.

Another option is Endoscopic Carpal Tunnel Release, which involves a small incision and the use of an endoscope—a small device equipped with a light and lens that enables visualization of the Carpal Tunnel without disturbing surrounding tissues. This method may include sedation and involves a small opening at the wrist crease, with a possible second incision in the palm. The surgeon uses the endoscope to guide a tube (cannula) alongside the Median Nerve, inserting a special instrument through the cannula to cut the Transverse Carpal Ligament, thereby enlarging the tunnel. This technique preserves more tissue in the palm, potentially leading to quicker recovery and reduced discomfort.

Post-surgery, the incision will be covered with a soft dressing, and the physician may recommend a splint for support during healing. Patients can typically move their fingers right after surgery but should avoid heavy gripping or pinching motions for about six weeks. Occupational or physical therapy may be suggested to regain strength, joint stability, and coordination, with full strength in the wrist and hand potentially taking several months to return.

Recovery experiences vary based on the severity of the condition and the type of surgery performed. Your doctor will provide guidance on what to expect.