CARPAL TUNNEL PROCEDURE

Corrective surgery – or ‘carpal tunnel release’ – involves cutting through the ligament exerting pressure on the carpal tunnel in the wrist, making more room for the median nerves and tendons which pass through the tunnel to the fingers.

At the day of the surgery, the patient can eat and drink. If s/he is on regular medication, s/he takes it as usual except for drugs affecting blood clotting (Anopyrin, Godasal, Trombex,etc.). These medications have to be discontinued before the surgery (usually for one week) so that blood clotting is not affected during the operation; if necessary, they can be replaced by substitutes such as Fraxiparine that do not interfere with the surgery while still protecting the patient from thromboembolic complications.

The operation is usually an out-patient procedure carried out under local anaesthetic, allowing you to go home on the same day. A method known as ‘endoscopic carpal tunnel release’ is employed, in which the surgeon inserts a very thin flexible tube with a camera at the end through a tiny incision in the wrist. The camera guides the doctor as he uses equally tiny instruments (introduced through another small incision) to cut the transverse carpal ligament causing the problem. The small incisions are then stitched up and the wrist put in a splint or heavily bandaged to prevent wrist movement while healing proceeds. Surgery does not last more than 5 minutes.

ENDOSCOPIC METHOD

The aim of the endoscopic operation of a narrow carpal tunnel is to increase its size while traumatizing the tissues in the palm of the operated hand as little as possible. We use a MicroAir monoportal system that makes it possible to access the carpal ligament via a single small approach in the wrist fold. Initially, it is necessary to increase the size of the carpal tunnel using dilators. Then, the working channel is placed upon the nerve and the ligament is transected from the deepest to the most superficial layers. The monoportal technique is the least invasive one, the tissues upon the carpal ligament are being preserved and the patient is left with only one scar on the wrist.

POST PROCEDURE CARE

The advantage of endoscopic surgery generally is that it reduces postoperative pain. After the surgery, the hand is being covered by an elastic (compressive) bandage for several hours to avoid the development of a larger subcutaneous hematoma. This bandage is then removed by the patient during the evening following the surgery, before the patient goes to sleep, and the hand remains free ever since. It is only the small scar at the wrist that remains covered by a minor plaster.

The main principle of physiotherapy following an endoscopic surgery is not to immobilize the hand (no splints or massive bandages). On the contrary, the patients are encouraged to use the operated hand soon for common activities. Patients are typically able within 1 to 2 days to involve the hand in activities requiring fine finger movements (holding, handing something or typing). However, holding anything (a door knob, knife, any tool) may by painful and uncomfortable for many days to weeks, this time being very variable. Some patients do not report any such problems, some are experiencing them for several weeks.

Up to 85% of our patients do not need any physiotherapy, either out- or in-patient, after the stitch is removed. The operated hand is usually in a good shape from the 7th post-op day onwards and it can be used for most common activities and sometimes even at work. Patients are advised to perform pressure massages of the palm and the scar, to extend the flexor tendons and to strengthen their clasp by compressing a small ball.