Carpal tunnel release surgery

It is a condition where the median nerve (nervus medianus) in the wrist is pressed.

The most common symptoms include pain in your fingers and wrists sometimes extending up to your forearms, impaired sensitivity of your fingers sometimes described as numbness, tingling (paraesthesia) in your fingers, morning swelling, and finger stiffness. The complaints may occur even at rest, but often appear at night and wake the patient up. Other complaints include impairment of fine motor skills, grip strength weakening, sometimes resulting in objects falling from hands.

If subjective complaints are significant (finger tingling, night pain, inability to work, etc.) or if an EMG finding is advanced, it is advisable to undergo surgery. The carpal tunnel is released by the surgery. The diagnosis is established on the basis of described complaints and EMG (electromyography test) finding. These examinations are carried out by specialised neurology units. The examination mainly detects the nerve conduction velocity and its reduction and clearly shows nerve compression beyond a certain limit.

Mostly outpatient. The compressed nerve is usually released by an open technique, i.e. with a larger or smaller scar in the palm of the hand. It is carried out under local anaesthesia when through longitudinal dissection of the transverse ligament in the wrist the structures present in the carpal tunnel, including the compressed nerve (nervus medianus), are released. Endoscopy reduces patients’ postoperative pain and makes it possible for them to return to work faster. Nevertheless, the long-term results after one year are comparable for both these surgical procedures. In an endoscopic carpal tunnel release, a short incision is cut on the wrist through which a special instrument with a built-in camera safely and under visual control cuts the transverse carpal ligament without injuring the tissues above the ligament.

 

Most patients undergoing this type of surgery do manual work in the ordinary course of their lives. That is why it is particularly important for them to restore their functions and be able to apply mechanical load to their hand(s) as fast as possible after the procedure. Significant pain relief may be expected within one or two days. Other complaints such as numbness, reduced sensitivity of fingers, or difficult handling of small objects, should disappear within a few weeks or months.

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