Patient education: Carpal tunnel surgery (The Basics)

What is carpal tunnel syndrome? — Carpal tunnel syndrome is a condition that causes pain, numbness, and sometimes weakness in the fingers and hands (figure 1). It happens when a nerve in the wrist called the "median nerve" gets pinched or squeezed.

The median nerve goes through a tunnel in the wrist. This tunnel is formed by the bones of the wrist and a tough band of tissue called a "ligament."

What is carpal tunnel surgery? — Surgery for carpal tunnel syndrome involves cutting the ligament that stretches across the wrist. This makes more room in the tunnel for the median nerve.

This surgery can be done in 3 ways:

●Open surgery – The doctor makes a cut (incision) across the wrist into the palm to see inside the wrist and get to the ligament. It might take you longer to return to normal activities if you had an open surgery.

●Endoscopic surgery – The doctor makes 1 or 2 smaller incisions in the wrist or palm. Then, they insert special tools through the incisions. One of the tools has a camera (called an "endoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the body.

●Ultrasound-guided surgery – The doctor uses ultrasound, a type of imaging, to decide where to make a small incision. Then, they insert a special tool through the incision to cut the ligament.

You might be able to return to normal activities sooner if you had endoscopic or ultrasound-guided surgery than if you had open surgery.

How do I prepare for carpal tunnel surgery? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get nerve tests, such as:

●Nerve conduction studies – These show whether the median nerve is carrying electrical signals the right way.

●Electromyography ("EMG") – This shows whether the muscles in the hand and wrist are responding the right way to electrical signals.

●Magnetic resonance imaging ("MRI") – This creates pictures of the inside of the wrist.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, the doctor will want you to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during carpal tunnel surgery? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain.

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make 1 or more incisions in the skin. Then, they will cut the ligament that stretches across the wrist to form the tunnel. This will take pressure off of the nerve.

●The doctor will close your incisions and cover them with clean bandages.

●The procedure usually takes about 60 minutes.

What happens after carpal tunnel surgery? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Most people can go home the same day.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●You will have a bandage covering the wound. Your doctor will tell you when you can take this off. You might be asked to keep your wrist still for a little while, but moving your fingers is encouraged.

●You will get medicine to help with pain, if needed.

What are the risks of carpal tunnel surgery? — Your doctor will talk to you about all of the possible risks and answer your questions. Possible risks include:

●Bleeding

●Infection

●Nerve injury

●Ongoing wrist pain

●The carpal tunnel syndrome coming back

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look for and when to call the doctor. Make sure that you understand your doctor or nurse's instructions. Ask questions about anything you do not understand.

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Patient education: Carpal tunnel syndrome (The Basics)
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