Carpal Tunnel Syndrome (CTS) Release

Carpal tunnel syndrome (CTS) is caused by compression of the median nerve at the wrist. This nerve compression causes numbness, tingling, weakness, and discomfort in the wrist and hand. The most common cause of CTS is the overuse of tendons in the wrist due to repetitive motion, which can cause irritation, swelling, and added pressure.

What is Carpal Tunnel Release?

Carpal tunnel release is a surgical procedure that is used for more severe cases of CTS, when the patient experiences considerably decreased sensation and loss of muscle strength. The procedure involves "releasing" the pressure in the carpal tunnel by cutting the roof of the tunnel, which is a ligament called the transverse carpal ligament.

Anatomy

The "carpal tunnel" is a tunnel in your wrist for the passage of nerves, tendons, and blood vessels. The floor and walls of the tunnel are formed by a group of bones (called carpals). The roof is made of a strong ligament called the transverse carpal ligament (on the inside of your wrist), which spans like a bridge over the group of bones creating a tunnel at the junction of your hand and wrist. The median nerve and tendons that move your fingers and thumb pass through this tunnel. In CTS, the pressure in the tunnel increases, compressing the median nerve.

The median nerve travels down your arm, through the carpal tunnel, and into your hand. It carries sensory impulses (feeling) from the thumb and four fingers on the palm (except for the little finger and half of the ring finger). Motor impulses are also carried to muscles in the hand, mostly in the thumb. When this nerve is compressed, there is a weakening of these muscles, as well as numbness, tingling, and aching in the palm of the hand.

Surgery

Traditional Open Carpal Tunnel Release
Carpal tunnel release surgery is an outpatient procedure that involves numbing the tissue around the wrist with a local anesthetic. During the procedure a small incision is made through the skin and underlying tissue on the bottom of the palm of the hand.

Once the transverse carpal ligament can be seen, it is cut through with sharp scissors or a scalpel. During this step, care is taken not to cut below the ligament, where the median nerve and tendons are running by. At this point, the pressure that was on the median nerve will be relieved.

The incision in the skin is then closed with stitches and covered with a soft bandage. You can leave this bandage on and keep it dry until the next time you come in to the office to have your stitches removed (usually in about two weeks).

Endoscopic Carpal Tunnel Release

Endoscopic carpal tunnel release is a new procedure for relieving the symptoms of carpal tunnel syndrome. The surgery is done using an endoscope, which is a tiny fiber optic camera at the end of a long tube. Your doctor can use this instrument to enter the carpal tunnel, look around at the nerves, tendons, and blood supply, and safely cut the transverse carpal ligament from the inside.

To insert the endoscope, your doctor will make an incision and place a cannula in the wrist up into the hand. A cannula is a piece of plastic tubing that the endoscope can slide safely inside. Your doctor then slides a tiny sharp knife shaped like a hook inside the cannula, positions it correctly, and then pulls it back through a slit in the side of the cannula, cutting the ligament as it goes. The cannula protects the nerve and blood vessels while the knife cuts the ligament. Following the procedure, the incision is closed with sutures (stitches) and a dressing is applied.

After Surgery

Your doctor will probably recommend that you restrict the use of the hand and wrist for several weeks after your surgery. Right after surgery, the pain and tingling will begin to disappear, but the incision area may be sore for a few months while the tissues heal. Your doctor may also recommend hand therapy provided by a physical or occupational therapist to help you during your rehabilitation. It is important to follow the instructions of your doctor and therapist exactly to ensure a good recovery.