If you are one of the 3-6% of US adults suffering from symptoms of carpal tunnel syndrome (CTS), you might consider carpel tunnel release surgery to alleviate numbness and tingling of hands and fingers, loss of grip, or wrist pain.
CTS occurs when the median nerve, which is responsible for movement of our hands, fingers, and wrist is compressed in the carpal tunnel—a narrow passageway in the wrist that contains tendons and is surrounded by ligaments and bones. Some of us have smaller tunnels than others, so carpal tunnel can be genetic. It can also be related to diabetes, rheumatoid arthritis, thyroid disorders, and pregnancy, as well as repetitive motion such as keyboarding.
In reality, says Brad Rockwell, MD, professor of plastic surgery and vice chair of academic affairs inthe Department of Surgery at University of Utah Health, it has to do more with the way the wrist is often flexed than the actual motion of typing on a keyboard or other repetitive motions.
Splints or steroids may alleviate symptoms for some patients, or help delay the need for surgery. But, according to Rockwell, surgery is the only sure cure.
The good news is that carpal tunnel release surgery is one of the most common and successful hand operations performed. Recovery is relatively quick but can depend upon how long the median nerve has been compressed within the carpal tunnel.
Endoscopic or Traditional Surgery?
Both plastic surgeons and orthopedic surgeons are trained in hand surgery, so either can perform carpal tunnel release surgery. By cutting through the ligament that is pressing on the carpal tunnel, more room is made for the median nerve and tendons located within the narrow space in the wrist. The surgery may be endoscopic or open release. The latter is the more traditional surgery, where the surgeon cuts through the wrist. Both are outpatient surgeries.
"Each technique has advantages and disadvantages when compared to the other," Rockwell says. "Most surgeons prefer one or the other. The final results in decompressing the nerve are equal when the results are compared." He also says that recovery times are similar.
What About Pain Management After Surgery?
Your surgeon will advise you about pain management. According to Rockwell, the regimen is usually a combination of acetaminophen and ibuprofen plus some type of pain pill. Several research studies from the last few years have looked at pain management after endoscopic surgery compared to open release. They have found that opioids are not needed in many instances, especially in the case of endoscopic surgery.
But I Really Can't Wait to Get Back to the Gym...
You will come home from surgery with either a bandage or splint. Follow your doctor's or nurse's instructions, which may include do's and don'ts, along with instructions about showering and bathing, antibiotics if prescribed, and pain management.
A few reminders regarding recovery:
- Don't lift anything heavier than 1-2 pounds.
- You may use your hand right away for light activities such as eating and getting dressed, but refrain from repetitious activities like typing, chopping food, vacuuming, or using a computer mouse or power tools.
- As discomfort lessens, driving may be possible in as little as 4 days.
- Keyboarding may be okay within 10 days.
- Recovery time for strenuous use may be 4-6 weeks or even longer, and yes, that includes the gym.
Most patients don't need formal physical therapy, which is common with other types of hand surgeries, but certain exercises may be prescribed.
"The hand will tell you if it is ready for a certain activity," Rockwell warns. "If your hand hurts with activity, avoid that activity. If you push your hand into activity before it is ready, healing and recovery will be delayed."
Call Your Doctor
Call your doctor if you observe any of the following post-surgery:
- Your hand is cool or changes color.
- Your splint feels too tight.
- Your stitches become loose, or your incision comes open.
- You have signs of infection including pain, swelling, warmth or redness, or a fever.
The post-operative bottom line is listen to your body and your doctor!