Carpal tunnel surgery is one of the most common surgeries performed by hand surgeons. To a surgeon, it’s a fairly straight-forward procedure with a very high success rate that they can sometimes perform multiple times per day. To the patient, this might be the first (and hopefully last) time they’ve agreed to let someone sedate them, cut their hand open and then sew them back up! Oftentimes, my patients have an understandable sense of unease and several questions about what to expect before, during and after surgery.
I thought I would address some of the more common questions for anyone that might be considering pursuing surgery as an option to resolve their own carpal tunnel syndrome.
Assessment of severity
After finding a hand surgeon, you may go through a few steps before you’re even cleared for a procedure, depending on severity of symptoms, the amount of time you’ve been experiencing these symptoms, and what health system or insurance you’re using. Less severe cases that haven’t been occurring as long may need to go through a few weeks of therapy, splinting and/or stretching and home exercise. Some surgeons may try a cortisone injection to resolve symptoms. You may also be asked to go through a nerve conduction study (NCS) to ascertain the amount of damage done to the nerve and to make sure that the point of median nerve impingement is actually at the carpal tunnel.
Scheduling the procedure
If you have a more severe case, or tried any of the above interventions and had a NCS done that showed sufficiently severe carpal tunnel syndrome, you will be scheduled for your procedure. The wait time will once again depend on the medical system or insurance plan you’re using and availability of the surgeon. If you have to wait a few weeks or longer, make sure you keep moving and stretching! The healthier all the structures are in your hand, the better recovery you’ll most likely have.
During the surgery
Generally speaking, there are two basic options for carpal tunnel release surgery: open and endoscopic. Open surgery means the incision is in the middle of the palm so the surgeon can directly visualize the carpal ligament that they need to cut. An endoscopic release means the surgeon makes an incision at your wrist just proximal to (“below” if you’re holding your hand in front of you) your palm. The surgeon then sends a scope up into your palm and cuts the carpal ligament from inside the carpal tunnel. Both of these procedures are usually done under local anaesthesia, oftentimes with mild to moderate sedation to keep you calm on the table.
Aftercare and recovery
Afterwards, you’ll need a safe way to get home and a few days to rest. Some people will feel immediate relief of nerve symptoms, others will need a little longer.
It will be a couple days before you should try to do light activities 2 weeks or so before you should be using your hands for everyday activities, 4-6 weeks before you should be doing repetitive pinching tasks or writing for long periods of time, and anywhere from 8 to 12 weeks before you should do any kind of heavy lifting/pushing pulling.
These are all very general guidelines for recovery times. Every person will have a different experience depending on the level of damage done to the nerve, age, other comorbidities that affect healing and the type of surgery performed. Ask your doctor what his specific recommendations are for recovery time.
It’s very normal to have lingering pain in the palm after surgery, sometimes for months! Incisional pain and pain on either side of the incision, called pillar pain, are common. Sometimes there may be an uncomfortable increase in neural pain as your brain tries to figure out how to interpret the new signals coming from your hand. Don’t be afraid to ask you doctor about any of these symptoms and possibly work with a certified hand therapist to reduce post operative symptoms.