Getting surgery for carpal tunnel syndrome

Surgery for carpal tunnel syndrome

How to know if I should have surgery for carpal tunnel syndrome? After the diagnosis, if conservative treatments (brace , anti-inflammatory drugs, etc.) have not been sufficient, surgery can be considered. Like any surgery, all the risks (anaesthesia, potential complications, trauma for example) should be taken into account before making a decision. Surgery can’t be suggested as a first-line treatment approach, except in case of advanced-stage disease.


Objective of surgical treatment

Surgery aims to reduce compression of the median nerve. To do so, the transverse carpal ligament is commonly cut to increase volume inside the carpal tunnel . It may sound radical but the ligament will naturally close during healing. The space in the carpal tunnel is larger and compression of the median nerve is limited. Nevertheless, the median nerve may have been irremediably damaged, so surgery can prove ineffective.


Types of surgery

Two main types of surgery are used: the standard technique and the mini-invasive technique.

The standard surgery, also known as the ‘open surgery’, releases the carpal tunnel thanks to a 3cm incision in the heel of the hand. The median nerve is no longer compressed. However, location of the scar can cause persistent discomfort, especially while using a walking stick. Also, this procedure may lead to slight strength reduction for gripping or squeezing. This technique, which enables the surgeon to perfectly see the nerve, almost totally eliminates the risks of complications.

The mini-invasive surgery has the same objective, but this time by endoscopic approach. The incision is then significantly reduced (around 1cm) and made in the wrist flexion crease. This avoids to damage the tissues in the palm of the hand and allows to keep good prehension movements. Post-operative recovery is then faster. Therefore, specific formation and material cost are both factors that limit the use of this surgical technique. In addition, it represents a risk of cutting the median nerve, especially if it is performed without camera. This only concerns a few cases out of a thousand, but implies almost irreversible sequelae that deeply affect the use of the hand and annihilate sensitivity in the first three fingers.

For both techniques, the surgical intervention is very fast. It lasts 10 to 20 minutes on average.


Before surgery

Even if surgery is performed under regional anaesthesia, preanaesthetic evaluation is necessary to assess your situation and avoid potential complications. During the surgical intervention, the patient is laid on his/her back. Only the arm is anaesthetised. Temporary tourniquet avoids the blood to flow to the wrist. For both procedures, the intervention is performed on an outpatient basis. It means you’re hospitalised, operated and free to go home the same day.


Carpal tunnel syndrome after surgery

Like any surgery, the one of carpal tunnel is followed by post-operative care. Indeed, it is important to regularly change the dressing and to control the scar. Analgesics are often prescribed in order to reduce post-operative pain. A little after surgical intervention, it is recommended to progressively reuse the fingers and wrist. If a gain or loss of motricity was observed before surgery, recovery can be partial and longer than usual. Rehabilitation sessions can highly favour recovery. You could transiently feel unpleasant sensations like tingling or numbness. However, they gradually decrease along with post-operative pain. It is crucial to properly follow your surgeon’s recommendations and to consult him in case of doubts. Follow-up consultation after surgery contributes to its success and helps for good healing.

*These products are medical devices that bear the CE marking under this regulation. Carefully read the instructions before use. Manufacturer: MILLET Innovation. 12/2021

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