What is carpal tunnel release surgery?

What is carpal tunnel release surgery?

‍

Carpal tunnel release is a surgical procedure performed to treat carpal tunnel syndrome (CTS). CTS is a common condition that occurs when the median nerve, which runs through the wrist, becomes compressed or pinched as it passes through the carpal tunnel—a narrow passageway formed by bones and connective tissues in the wrist.

‍

The compression of the median nerve can lead to symptoms such as pain, numbness, tingling, and weakness in the hand and fingers, typically affecting the thumb, index finger, middle finger, and part of the ring finger.

‍

Carpal tunnel release surgery is done to relieve the pressure on the median nerve, thus alleviating the symptoms of CTS. There are two main methods of carpal tunnel release:

‍

1. Open Carpal Tunnel Release: In this traditional approach, a small incision is made in the palm of the hand, and the surgeon cuts the transverse carpal ligament—a tough band of tissue that forms the roof of the carpal tunnel. By cutting the ligament, the tunnel is widened, releasing the pressure on the median nerve.
2. Endoscopic Carpal Tunnel Release: In this minimally invasive approach, the surgeon makes one or two small incisions in the wrist and palm. An endoscope—a thin tube with a camera on its tip—is inserted through one of the incisions to visualize the carpal tunnel. Special surgical instruments are then used through the other incision to cut the transverse carpal ligament, similar to the open technique.

‍

Both techniques aim to achieve the same result—increasing the size of the carpal tunnel to reduce pressure on the median nerve and alleviate the symptoms of CTS.

‍

When would a patient need carpal tunnel release surgery?

‍

Carpal tunnel release surgery can benefit individuals who have carpal tunnel syndrome (CTS) that does not respond to conservative treatments or whose symptoms are severe and significantly affect their quality of life and daily activities. Carpal tunnel release surgery may be recommended when:

‍

1. Conservative Treatments Have Failed: If non-surgical treatments, such as rest, wrist splinting, anti-inflammatory medications, and corticosteroid injections, have not provided sufficient relief from CTS symptoms, surgery may be considered.
2. Persistent and Severe Symptoms: Individuals experiencing persistent and severe symptoms of CTS, including hand pain, numbness, tingling, and weakness that interfere with daily activities and work, may benefit from surgery.
3. Nerve Damage: In cases where CTS has led to nerve damage and muscle weakness in the hand, surgery may be necessary to prevent further deterioration and promote nerve recovery.
4. Progressive Symptoms: If CTS symptoms are progressively worsening, or if there is evidence of nerve compression on nerve conduction studies or imaging, surgery may be recommended to prevent permanent nerve damage.
5. Recurrent CTS: For some individuals who have previously undergone conservative treatments or even a previous carpal tunnel release but experienced a recurrence of CTS symptoms, revision surgery may be considered.

‍

It's important to note that not all cases of CTS require surgery. Many individuals with mild to moderate CTS symptoms can find relief through non-surgical treatments and lifestyle modifications. Carpal tunnel release surgery is typically considered when conservative treatments have failed or when the severity of symptoms warrants surgical intervention.

‍

The decision to undergo carpal tunnel release surgery should be made in consultation with a hand surgeon or orthopedic specialist who specializes in hand and wrist conditions. The surgeon will thoroughly assess your CTS symptoms, medical history, response to conservative treatments, and overall health to determine if carpal tunnel release is the most appropriate treatment option for your specific case.

‍

After carpal tunnel release surgery: What to expect

‍

After carpal tunnel release surgery, the recovery process is crucial to ensure proper healing and successful rehabilitation. Here's what you can generally expect during the recovery period:

‍

1. Hospital Stay: Carpal tunnel release surgery is typically performed on an outpatient basis, meaning you can go home the same day of the surgery.
2. Dressings and Wound Care: You will have dressings over the surgical site, and your surgeon will provide instructions on how to care for the wound and when to change the dressings.
3. Pain Management: You may experience some pain, swelling, and discomfort in the hand and wrist after the surgery. Your healthcare team will prescribe pain medications to manage post-operative pain.
4. Wrist Immobilization: Depending on your surgeon's preference and the type of surgery performed (open or endoscopic), the wrist may be immobilized 7 to 10 days postoperatively in slight extension with the fingers free to move. When allowed, protective splinting can be removed during therapy. 
5. Stitches or Staples Removal: If non-absorbable stitches or staples are used, your surgeon will schedule a follow-up appointment to remove them once the wound has healed sufficiently.
6. Rehabilitation Program: Physical therapy or hand therapy may be recommended to help restore hand strength, flexibility, and function.
7. Gradual Return to Activities: Your surgeon will provide guidelines for gradually resuming daily activities and light tasks. Avoid heavy lifting or repetitive motions with the hand until cleared by your surgeon.
8. Follow-up Appointments: You will have regular follow-up appointments with your surgeon to monitor your progress and ensure proper healing.
9. Scar Management: Your surgeon may recommend scar massage or other scar management techniques to help minimize scarring.
10. Timeframe for Full Recovery: The recovery period varies from person to person, but most individuals can expect significant improvement within a few weeks to a few months after surgery.

It's essential to follow your surgeon's instructions diligently and attend any scheduled follow-up appointments to ensure a successful recovery. Adhering to post-operative care guidelines and any prescribed physical therapy exercises will lead to the best possible outcome, allowing you to regain hand function and return to your daily activities with reduced pain and improved hand mobility.

‍

How can physical therapy help? 

‍

Physical therapy plays a vital role in the recovery process after carpal tunnel release surgery. A physical therapist will design a customized rehabilitation program to promote healing, restore hand and wrist strength and flexibility, and guide you back to your normal activities. Here's how physical therapy can help with carpal tunnel release:

‍

1. Pain Management: Physical therapists use various modalities such as ice, heat, and electrical stimulation, to manage post-operative pain and reduce hand and wrist swelling.
2. Wound Care: Physical therapists can assist with wound care and scar management to promote proper healing and minimize scarring.
3. Range of Motion Exercises: Early after surgery, physical therapists focus on a gentle range of motion exercises such as; active finger, thumb and wrist range of motion exercises within the pain-free range to prevent muscle stiffness and maintain the range of motion of the affected wrist and hand. As the patient improves, progressive stretching and joint mobilization exercises are utilized to lengthen the restricted tissues and increase the range of motion.  
4. Tendon and Nerve Gliding Exercises: Tendon gliding and nerve gliding exercises are an important part of the postoperative rehabilitation program for carpal tunnel release, to prevent adhesion formation from restricting motion in the carpal tunnel.
5. Strengthening Exercises: As healing progresses, physical therapists prescribe progressive strengthening exercises. It includes isometric exercises (static contraction of muscles) for the wrist and hand, and later on will progress to grip and pinch exercises. Emphasizing strength, coordination and endurance toward functional goals.  
6. Scar Tissue Mobilization: Physical therapists may perform scar tissue mobilization techniques to the palmar fascia (palm of the hand) and scar, it will help to promote tissue healing and reduce scar adhesions.
7. Dexterity Exercises: As soon as the signs of motor recovery occur, dexterity exercises are initiated. It includes picking up small objects using different prehension (grasping) patterns (e.g. pad-to-pad, tip-to-tip and tip-to-pad), turning over cards, stacking checkers, writing, and opening a jar lid. These exercises may also help to improve the strength and functional mobility of the affected fingers.
8. Sensory Stimulation and Re-Education: For individuals who experienced numbness or altered sensation due to carpal tunnel syndrome, desensitization of hypersensitive skin is a priority. Physical therapists will help to desensitize and reprogram sensory awareness. 
9. Functional Training: A final component of an individualized rehabilitation program involves practicing activities that simulate the physical demands of a patient’s work or desired recreational or sport activity. Simulated activities and drills enable a patient to practice under supervised conditions to receive feedback on correct wrist and hand mechanics. 
10. Patient Education: Physical therapists educate the patients about carpal tunnel release, its indications and benefits as well as the role and importance of postoperative rehabilitation programs. They also teach the patients about  proper hand and wrist care, activity modifications, and injury prevention strategies.
11. Home Exercise Program: A specialized home exercise program is provided by the physical therapists. They also teach patients how to safely incorporate it into their daily routine to reinforce the intervention and for optimal recovery. 
12. Progress Monitoring: Physical therapists continually monitor your progress and adjust the treatment plan as needed to ensure a successful recovery.

‍

Physical therapy is essential to optimize your recovery after carpal tunnel release surgery. The therapist's expertise and guidance are instrumental in promoting healing, preventing complications, and helping you regain hand and wrist function. Consistent participation in physical therapy exercises and adherence to your therapist's recommendations will lead to the best possible outcome, allowing you to return to your desired level of hand function and safely resume daily activities and work tasks.

Trust PeteHealth for recovery from carpal tunnel release surgery

Looking for a physical therapist to help you recover from carpal tunnel release surgery? PeteHealth is the trusted physical therapy solution that you can access on your schedule, bringing you the care you need wherever you need it – including your home or office. Our licensed physical therapists are at the top of their profession, and we accept most insurance carriers.

‍

Finally – the all-in-one, professional, convenient approach to physical therapy that you deserve with PeteHealth.

‍