The carpal tunnel is a passageway through the wrist carrying tendons and one of the hand's major nerves. Pressure may build up within the tunnel because of disease (such as rheumatoid arthritis), injury, fluid retention during pregnancy, overuse, or repetitive motions. The resulting pressure on the nerve within the tunnel causes a tingling sensation in the hand, often accompanied by numbness, aching, and impaired hand function. This is known as carpal tunnel syndrome.
In some cases, splinting of the hand and anti-inflammatory medications will relieve the problem. If this doesn't work, however, surgery may be required. Prior to surgery, you will be referred to a neurologist for nerve conduction studies – which will confirm and grade the severity of carpal tunnel syndrome.
Dr Vrtik performs open carpal tunnel release. In the operation, an incision is made from the middle of the palm to the wrist. A cut will be made to divide the tissue that's pressing on the nerve, in order to release the pressure. Surgery is usually performed under general anaesthesia. However, in some cases, the surgery can be done under local anaesthetic with intravenous sedation. A plaster will used after surgery to restrict motion and promote healing. The scar will gradually fade and become barely visible.
Carpal tunnel release is performed as Day Surgery; it is essential that you arrange for someone to drop you off and pick you up after surgery. It is also important that a responsible adult stays with you for the first 24 hours postoperatively.
Recovery from your surgery will also depend on adequate postoperative rest and hand therapy. The plaster is usually removed after 5-7 days, after which your wound is taped for support and the hand therapist will show you range of motion exercises for your wrist. Your sutures will be removed after 14 days, and then taped for support for another 2 weeks. Massage on the scar is essential to decrease the risk of hypertrophic scarring and also to desensitise the area. No heavy lifting, weight bearing or repetitive work is allowed for a minimum of 6 weeks. Sensitivity and pain around the scar, wrist, and the base of the thumb may persist for up to 3 months after surgery. Rest, massage and hand therapy are the mainstay treatments to return the hand to normal function.
The results of the surgery will depend in part on how long the condition has existed and how much damage has been done to the nerve. For that reason, it's a good idea to see a doctor early if you think you may have carpal tunnel syndrome.
(Some information is courtesy of the American Society for Surgery of the Hand)