Carpal Tunnel Syndrome/Repair

What is it?

The “carpal tunnel” is a narrow passageway that runs from the base of the hand through the wrist. The median nerve, which controls our sense of touch in the palm, fine movement in the thumb and middle finger, passes through the carpal tunnel along with several tendons. If any of those tendons become irritated, or any other swelling encroaches on the space within the tunnel, the median nerve can become compressed. Compression of the median nerve may cause symptoms that range from tingling in the fingers to pain radiating up the arm.

In order to properly diagnose carpal tunnel syndrome your doctor may order any of the following tests in addition to the physical examination:

X-rays
Electromyogram (EMG) - a thin needle electrode is inserted into specific muscles and evaluates the electrical activity of the muscles when they are contracting and at rest. This can determine if muscle damage has occurred and can be useful in ruling out other conditions
Nerve conduction study- using electrodes, a small shock is passed through the median nerve to see if the electrical impulses are slower in the carpal tunnel. This confirms diagnosis and rules out other conditions.

What are the treatment options?

There are some things that you can do to provide temporary relief. Taking breaks from repetitive motion and rotating and stretching the wrists as well as palm and fingers will help reduce irritation. At night, you should try to avoid sleeping on your hands and if necessary wear a wrist splint to make sure that you are not putting additional pressure on that median nerve.

Carpal tunnel should be treated as soon as symptoms begin to arise. Mild cases can often be treated with rest and avoiding activities that irritate the nerve and cause symptoms to worsen. If swelling occurs, applying an ice pack can reduce this.

Wearing a splint on the wrist that holds it in place while you are sleeping is also a valid treatment option to relieve nighttime symptoms such as tingling and numbness. Your doctor may also suggest that you take nonsteroidal anti-inflammatory drugs or that you get a corticosteroid injection such as cortisone in the wrist to relieve pain.

If symptoms continue to persist, surgery may be the next step.

Procedure Goals

The goal of carpal tunnel surgery is to relieve pressure that is being placed on the median nerve by cutting away the ligament that is pressing on the nerve.

Risk Factors

There are a number of factors that may increase your risk of developing carpal tunnel syndrome:

Anatomic factors- a wrist fracture or dislocation that altered the space within the carpal tunnel. Individuals with smaller carpal tunnels are at an increased risk to have carpal tunnel syndrome
Carpal tunnel is more common in women than in men
Chronic illnesses such as diabetes that increase your risk of nerve damage
Illnesses characterized by inflammation such as rheumatoid arthritis can illicit extra pressure on the median nerve
Fluid retention which is common during pregnancy or menopause may increase pressure within the carpal tunnel
Other medical conditions: menopause, obesity, thyroid disorders or kidney failure
Working with tools that vibrate or on an assembly line that requires repetitive flexing of the wrist As with all surgical procedures there are complications that occur. For carpal tunnel release, complications include infection and nerve damage. Before surgery your doctor will review the possible risks and complications of surgery with you.

What to Expect

Before Procedure

The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home.

Wear comfortable clothing.

Do not eat or drink anything after midnight for arrivals before noon. Otherwise, do not eat or drink anything seven hours prior to your arrival at the surgery center.

You will be contacted by Lawrence Surgery Center to set up your patient account. They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery.

After Procedure

Your goals during recovery are to manage your symptoms and regain pain-free wrist strength and function. Many people experience improved symptoms soon after surgery. It can take 2 to 6 months to see improvements in grip and pinch strength. And full recovery can take up to a year.

Some swelling and stiffness are common after surgery. You can minimize this by elevating your hand above your heart and moving your fingers frequently for the first couple of days. Pain is also common, but tends to resolve more quickly after endoscopic surgery. Controlling pain is key because it helps you complete rehabilitation and recover.

Discharge Instructions

Diet

You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.

Hand Care & Bathing

Keep your dressing and/or splint in place until your first post-op visit
Your dressing will be changed at your first post-op appointment
No bathing or swimming until the bandages are removed
If the tegaderm dressings become loose or fall off replace with over the counter water proof bandages
Keep incision dry until sutures are removed
Use gloves to cover the incision site when/if you are washing dishes.

Elevation and Circulation

Elevate the extremity on pillows with fingers point toward the ceiling as much as possible for the first 3-5 days.
After these first few days, continue to elevate as needed in order to reduce swelling.
To encourage circulation and decrease swelling, wiggle your fingers, thumb and wrist several times each hour.

Cold Therapy

To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48 hours and then as needed to help control pain and swelling.
To avoid frostbite, place a towel or t-shirt between the ice pack and your skin.
It is not necessary to use ice while sleeping.

Pain Medication

Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery. Do not take any additional Tylenol.
While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off.
No driving while taking any narcotic pain medication!
The pain medication may cause some nausea so take it with food.
The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation.

Follow-up Care

Watch for temperature > 101.5F, persistent numbness and tingling, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room.
Please make sure to follow instructions given to you by your physician, they may have specific instructions to your care.
If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125.

Rehabilitation Plan

Rehabilitation after carpal tunnel release may include occupational therapy. You will be placed in a wrist brace for a couple weeks following your surgery. Therapy and home exercises will initially focus on regaining range of motion at the wrist and will progress to strengthening activities. You may also need to be seen for edema and scar management.

It can take several weeks to several months until you are able to return to all your normal activities. However, as you heal, you should try to use your hand as normal as possible. This includes using it for daily tasks such as holding utensils, brushing your teeth and bathing. Heaving lifting, however, should be avoided for approximately six weeks. Follow the instructions given to you by your doctor or therapist, as doing too much too fast can cause pain and swelling.

It’s possible for carpal tunnel syndrome to happen again and require another surgery. Your occupational therapist can show you strategies to help prevent this. Your therapist will teach you safe ways to use your wrist and exercises to strengthen it. It may also be necessary to change the way you work or how you position your wrist while you work. Following your therapist’s tips for reducing stress on your wrist can help you avoid future problems with carpal tunnel syndrome.