Open Carpal Tunnel Release
This procedure is performed to relieve pressure on the median nerve, alleviating the pain of carpal tunnel syndrome and restoring normal sensation to the hand and fingers. The procedure is usually performed on an outpatient basis.
Open carpal tunnel release is an outpatient procedure performed to relieve pressure on the median nerve in order to reduce symptoms of carpal tunnel syndrome. Carpal tunnel syndrome, or CTS, is caused by irritation or compression of the median nerve inside the carpal tunnel, which results in symptoms including a numbness or tingling sensation in the fingers. The carpal tunnel is a narrow passage in the wrist protecting the median nerve, which runs down the length of the arm and through the wrist into the hand.
The median nerve controls some hand movement, as well as sensation in the thumb, index and middle fingers, and part of the ring finger. Open carpal tunnel release involves cutting the transverse carpal ligament, to relieve pressure placed on the median nerve.
Symptoms of Carpal Tunnel Syndrome
Carpal tunnel syndrome develops gradually, usually beginning as an ache in the wrist that extends up the forearm or down into the hand. As CTS worsens, there may be tingling or numbness in the fingers, or pain radiating through the entire arm. Some people also experience weakness in the hand and arm, and have difficulty grasping small objects.
Risk Factors for Carpal Tunnel Syndrome
In most cases, the causes of CTS remain unknown. In some instances, CTS may be the result of genetic predisposition, with some people having atypically small carpal tunnels, making the median nerve more susceptible to irritation. Whether CTS is caused by repetitive motions such as using a computer mouse has not been proven conclusively. Risk factors for CTS include the following:
- Inflammatory conditions, such as arthritis
- Thyroid disorders
- Kidney failure
- Use of oral contraceptives
Diagnosis of Carpal Tunnel Syndrome
CTS is usually diagnosed through a complete medical history and physical examination. A diagnostic test such as an electromyogram, which records the electrical activity of nerves and muscles, may be performed.
The Open Carpal Tunnel Release Procedure
Open carpal tunnel release is performed for the most severe cases of CTS. This procedure helps to restore muscle strength and dexterity to the hand, and is typically reserved for patients who have had persistent (lasting longer than 6 months) symptoms that have not responded to conservative treatment methods.
Performed under general or local anesthesia, open carpal tunnel release surgery involves the creation of a 2-inch incision in the middle of the palm. It is advantageous in that it provides the surgeon with a direct view of the treatment area, so there is less risk of accidentally damaging nerve tissue than there is with an endoscopic procedure.
The transverse carpal ligament is cut to alleviate pressure on the median nerve. Once the ligament is cut, the skin is closed with stitches. The gap in the ligament eventually fills with scar tissue. Patients can typically return home the day of surgery.
Recovery from Open Carpal Tunnel Release
After open carpal tunnel release surgery, the hand is wrapped. Stitches will be removed 10 to 14 days later. Pain and numbness are common post- surgery, and may take several months to subside completely. Patients should avoid heavy use of the treated hand for up to 3 months after surgery, and use the opposite hand to perform any repetitive or high-risk activities since hand function will be limited. In most cases, patients can return to work within one week.
Risks of Open Carpal Tunnel Release
The potential risks of open carpal tunnel release are considered very low. Although nerve damage is a possible complication of the surgery, it is extremely rare. There is also a small risk for median nerve or tissue damage during surgery. Other possible complications of the procedure include:
- Persistent pain in the wrist or hand
- Redness, tenderness, bleeding, swelling or infection at the surgical site
Considerations of Open Carpal Tunnel Release
Open carpal tunnel release often requires a longer recovery period than endoscopic surgery to treat carpal tunnel syndrome, which may not make it an ideal procedure for every patient. Undergoing a physical therapy program may also be necessary for a full recovery following open carpal tunnel release. Physical therapy can provide the patient with an exercise regimen designed to improve the mobility of both the wrist and hand.