Carpal Tunnel Repair

What is carpal tunnel syndrome and how can surgery help?

Carpal tunnel syndrome occurs when the median nerve (which runs from the forearm into the hand across the palm side of the wrist through the carpal tunnel), becomes pressed or squeezed at the wrist, causing pain, swelling, numbness or tingling in the palm or fingers. The signs and symptoms may be mild, moderate or severe and usually worsen without treatment. The syndrome occurs more often in women than men.

Carpal tunnel syndrome may be caused by a variety of factors including:

• Genetics (people born with small carpal tunnels may be predisposed to this syndrome)
• Injury (for example, a sprained or broken wrist)
• Rheumatoid arthritis
• Diabetes
• Thyroid disease
• Repeated strain (vibrating tools are much more likely to cause difficulty than excessive keyboarding)
• Fluid retention during pregnancy or menopause
• A cyst or tumour in the canal
• In some cases, no specific cause can be found.

To treat carpal tunnel syndrome, physicians usually recommend starting with rest (including immobilizing the wrist with a splint), anti-inflammatory drugs and exercise. If the symptoms fail to improve after three to 12 months, many physicians will recommend surgery.

In the surgery, the transverse carpal ligament is cut which releases pressure on the median nerve. This relieves the symptoms.

Why do I have to wait so long for carpal tunnel repair surgery?

Unless you have nerve damage, which may be viewed as an emergency, your carpal tunnel repair will be seen as “elective.” As a result of rationing of care by the Canadian public health system and limited operating room times for surgeons, this means your surgery may be delayed and will be subject to being cancelled. Timely Medical Alternatives can help you find a private clinic to expedite your case so you can get the surgery you need as quickly as possible.

What are the different surgical options for me?

There are two types of carpal tunnel repair surgery: open and endoscopic. Both are generally performed under local anesthetic.

In open-release carpal tunnel surgery, the surgeon makes a small incision (about one to three inches long) in the base of the palm, sometimes extending into the wrist. He or she then cuts the transverse carpal ligament and it springs open, providing more space for the median nerve. The incision is then closed with stitches.

In endoscopic surgery, the surgeon makes one or two incisions that are approximately ½ inch long. Through one of these incisions, he or she then inserts an endoscope (small camera). The camera lets the surgeon see the transverse carpal ligament so it can be cut safely. The incision is then closed with stitches.

The advantage of an endoscopic surgery is less post-surgical pain and a smaller scar. The downside is a slightly higher risk of requiring a second operation – in the event the carpal ligament hasn’t been fully cut. You may also not be eligible for endoscopic surgery if you have abnormal nerve anatomy, a tumour, scarring or have had a previous carpal tunnel repair surgery.

Your surgeon is the best person to help you decide what approach will be best for you.

How long will it take me to recover from carpal tunnel repair surgery?
Most patients will need to wear a post-operative splint for four to five days until the stitches are removed. If you have had surgery on your dominant hand (the one you use the most) and the original injury was caused by work activities – especially heavy lifting and repetitive movement — you may need several months before you can return to work. Physiotherapy will help speed the process. If the surgery was on your non-dominant hand and your work does not involve lifting or repetitive activities that put stress on your hands or wrist, you may return to work within a few days to two weeks. Your surgeon can give you an estimate of anticipated recovery time at the time of your consultation.

What can I expect when I’m fully recovered?

In most people, the worst symptoms are usually immediately relieved by surgery. But full recovery and building up strength in the wrist can take a number of months. Again, physiotherapy will usually help speed the process.