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Tunnel syndrome: surgery, preparation for the procedure, anesthesia, detailed analysis


This article is co-written by Jonas DeMuro, MD. Dr. DeMuro is a certified pediatric surgeon, specialist in emergency surgery from New York. He graduated from Stony Brook University School of Medicine in 1996.

The number of sources used in this article is 13. You will find a list of them at the bottom of the page.

A section of the carpal tunnel muscles is an extreme treatment for carpal tunnel syndrome, which could not be cured by more conservative methods. Surgery can significantly improve the condition of the disease or lead to complete healing. However, the operation carries some risk, and recovery from it is quite lengthy. The recovery period usually lasts from several weeks to several months. Purposefulness is needed to undergo a course of physiotherapy, which will help strengthen and restore the wrist and arm after surgery.

Preparation for the procedure

Shooting pain in the arm usually signals carpal tunnel syndrome. The bones and ligaments of the wrist form a tunnel, a passage for the median nerve and tendons of the fingers.

Repeated stress can cause tissue edema, which traps the nerve in the tunnel, as if in a trap. An accurate diagnosis excludes other joint or muscle problems that can mimic this syndrome.

Signs of carpal syndrome

At the medical examination, the doctor checks the sensitivity, strength and appearance of the neck, shoulders, wrists and hands, asks about the pain in the arm, including possible causes, and also conducts tests indicating a median nerve compression.

During the examination, you must inform your doctor about any health problems (such as diabetes), deformities, or recent injuries to your wrist, hands, or neck.

Any of these problems can affect the median nerve. It is also necessary to describe the daily routine and everything that could strain or damage the wrist.

Your doctor may order blood tests to help identify health problems that caused pain symptoms.

If there are signs or symptoms of impaired nerves or muscles, the doctor may prescribe electromyography (EMG) with tests for nerve conduction.

Electromyography records the electrical activity of muscles. Testing involves the study of nerve conduction in the study area - with tunnel syndrome, the speed of nerve conduction is lower than usual.

The type of arising pain is also experienced - shooting, burning or shock pain is felt.

The results will show if the pain is related to the median nerve or something else. If neural seizure is involved, your doctor will discuss possible treatment options.

A surgical treatment that frees up nerve space may be a good treatment option for this condition.

This method is usually used if testing confirms that the median nerve is being taken, or if pain, weakness and numbness persist after other treatment procedures. After surgery, the tissue is restored with sufficient space for the passage of the nerve.

Surgical treatment can be performed either by an open method or through endoscopic technique. Both methods of surgical intervention are performed on an outpatient basis, require small incisions and take only about 10 minutes.

Both procedures include cutting the carpal ligament to relieve pressure on the median nerve. Recovery depends on the size of the incision and the general condition of the patient.

No special restrictions are included in preparing the patient for surgery. Food or drink is allowed the night before the operation.

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The use of sedatives reduces anxiety and helps to relax.

Directly next to the future incision, local anesthesia is used to block nerves.

Sometimes, to relieve pain, a drug may be administered to necrosis of part of the nerves in the operated space.

An ice pack over the dressing is also used to help reduce bleeding and swelling.

Open surgery

  1. After anesthesia, an incision is made from the base of the wrist to the middle of the palm 3-5 cm long, opening the carpal tunnel.
  2. The edges of the skin fold back to open the wrist. The lower surface of the ligament is separated to protect the nerve and tendons located below.
  3. An incision is made in the ligament to open the tunnel and release the median nerve.
  4. The section is closed with several stitches made in a fold in the palm of your hand. The wound is covered with a bandage.

Endoscopic surgery

  1. This method involves the use of an endoscope. After two small incisions are made in the wrist and palm, an endoscope equipped with a small camera is inserted into them.
  2. Looking through the tunnel of the wrist through the endoscope, the surgeon cuts the ligaments from below to release the median nerve. If necessary, the procedure can be switched to an open operation.
  3. The incision is closed with stitches, and the wound is covered with a bandage.

Possible complications

For a short time, the patient is placed under the supervision of a doctor. When the doctor considers that the operation was favorable and the condition of the hand is stable, you can leave the surgical center.

If any complications arise, it may take longer to observe and correct the results.

Mild pain, discomfort, and swelling are fairly common after surgery. Your doctor may recommend ice, raising your arms to drain blood and reduce swelling, over-the-counter painkillers, or a splint that needs to be worn at night or during events.

Sutures are removed 7-10 days after surgery in the doctor’s office.

Standard rehabilitation techniques include:

  1. In case of discomfort, pain or swelling during the first 48 hours after surgery, you need to rest by raising your hand at chest level on the pillow. You can use an ice pack on your arm for 15 minutes several times a day.
  2. Immediately after surgery, pain is controlled by drugs. Since narcotic drugs are addictive, they are prescribed for a period of two weeks or less. Their regular use can cause constipation, so you need to drink plenty of water and eat foods high in fiber. Laxatives to relieve constipation can be purchased without a prescription.
  3. After the initial period, pain is controlled by acetaminophen (for example, Tylenol) and non-steroidal anti-inflammatory drugs (Aspirin, Ibuprofen, Nuprin, Naproxen sodium, etc.).
  4. Restrictions after surgery - you cannot lift anything heavy with your operated hand for one month. It is necessary to avoid actions that put pressure on the palm, for example, entering text on a computer or working with tools (for example, screwdrivers, hammers) until the surgeon determines that everything is okay with the hand.
  5. No dietary restrictions are shown. A healthy diet is recommended.
  6. Physical rehabilitation involves the gradual onset of soft movements with the wrist after approval by the surgeon. The load during stretching and strengthening should be increased gradually. Possible pain is a signal to reduce the load.
  7. You can take a shower one day after surgery, unless otherwise indicated.
  8. It is important to keep the dressing dry and clean and replace it as necessary.
  9. Your doctor may also limit the amount of weight that you can lift with your operated hand.

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Prolonged chronic carpal tunnel syndrome, commonly seen in older people, can lead to permanent nerve damage.

Namely, to the following: to irreversible numbness, muscle exhaustion and weakness in the hand.

Studies show that psychological problems or alcohol use give significantly lower overall treatment outcomes.

Renewal of carpal tunnel syndrome after successful surgery is quite rare.