Decompression surgery for carpal tunnel syndrome

Carpal tunnel syndrome occurs when there is pressure on the flexor part of the wrist that exerts pressure on the median nerve.

Conservative treatments often fail and the patient suffers daily pain. In these cases, the specialist traumatologist is likely to recommend surgery to solve the problem.

What is carpal tunnel?

The carpal tunnel is a channel located in the flexor area of the wrist, formed by bones and a ligament called the flexor retinaculum. The median nerve and the flexor tendons of the fingers pass through this tunnel. The median nerve is responsible for sensitivity and motor control of some fingers and muscles of the hand.

Causes and symptoms of carpal tunnel syndrome

Carpal tunnel syndrome It occurs when the median nerve, which passes through the carpal tunnel in the wrist, is compressed.This compression can be caused by different factors. Repetitive hand and wrist movements, common in certain work activities such as the constant use of tools or electronic devices, can increase pressure in the carpal tunnel. In addition, some people are born with a smaller carpal tunnel, which may predispose them to developing the syndrome.

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Other medical conditions, such as rheumatoid arthritis, diabetes, hypothyroidism, or pregnancy, may also contribute to the syndrome, as these conditions can cause swelling in the tissues of the wrist. Previous injuries, such as fractures or sprains, can alter the structure of the carpal tunnel and promote nerve compression.

Symptoms of carpal tunnel syndrome usually develop gradually and include tingling, numbness, pain in the wrist and hand, weakness in the hand, and sometimes a feeling of swelling.

Diagnosis of carpal tunnel syndrome

When attending the consultation, the orthopedic surgeon will make a general evaluation based on certain questions, establishing the patient's medical history and listening to what the patient feels. Subsequently, a careful analysis of the affected area will be carried out along with a series of physical tests that consist of:

• Flex and straighten your wrists to determine if tingling or numbness of your hands (known as Phalen test).
• Give light blows along the median nerve to see if this reproduces the symptoms (a test technically known as Tinel).
• Check the level of sensitivity that exists by gently touching, without the patient looking, the hands and fingers.
• Examining the strength of the motor muscles found at the base of the thumb. He will also evaluate that none of these muscles are atrophied.

Once the physical assessment has been carried out, the specialist can determine that more tests are needed to diagnose the level of severity that exists, that is, if it is a mild pressure on the nerve or if there is severe damage. Among the most frequent tests we can highlight x-rays, ultrasounds and magnetic resonance imaging.

In addition, to assess nerve damage prior to decompression surgery, your specialist may request electrophysiological testing to determine signal levels in nerve conduction and electrical activity in the muscles.

When is carpal tunnel syndrome surgery necessary?

Surgery should always be considered as the last measure to be taken, since any intervention carries risks that should be avoided with more conservative treatments. However, there are some cases in which surgery is not recommended. trauma team You may consider it better to perform a decompression surgery. Such cases include:

• After a prolonged period of non-surgical treatment, where the patient does not show improvement or the symptoms persist. A good orthopedic doctor will try more conservative treatments before recommending surgery unless there is a diagnosis of permanent nerve damage.
• The symptoms are serious and affect the normal development of the patient's activities, such as lack of coordination or strength that prevents normal use of the hand.
• Damage or risk of damage has been diagnosed. neurological damage to the median nerve.

Ultimately, mild cases of carpal tunnel syndrome usually do not require surgery, as they can be managed with conservative treatment. However, in more advanced or severe situations, surgical intervention becomes the only viable option to relieve nerve compression and prevent further damage.

Non-surgical carpal tunnel syndrome treatments

Before recommending surgery, whether open or endoscopic, a good orthopedic doctor will try non-surgical solutions to relieve symptoms. Common treatments include:

• Use of anti-inflammatories: these help reduce existing inflammation and calm pain. If the pressure on the nerve is very slight, that anti-inflammatory may be enough to free the channel.
• Use of a splint to immobilize the wristThis way, the area can rest and the inflammation will naturally decrease thanks to this rest. Likewise, it will be recommended that you stop certain activities that the specialist considers may be harmful, for example, using a mouse at work.
• Stretching exercises that allow more space for the median nerve.

Carpal tunnel surgery

Carpal tunnel surgery is performed to decompress the canal carpal through which the median nerve passes, releasing that pressure and eliminating the symptoms suffered by the patient.
There are two surgical techniques for carpal tunnel decompression:

• Open surgery: It is the most conventional option and is performed by sectioning the carpal ligament through an incision in the palm of the hand.
• Endoscopic carpal tunnel surgery: This technique is also known as wrist arthroscopy It is performed using a very small camera (arthroscope) that is introduced through tiny cuts in the palm of the hand, less than 5 millimeters.

The latter is the most sophisticated option. The most experienced traumatologists use this technique since it is the least invasive option and requires a much faster recovery than with open surgery. In addition, the scar is almost imperceptible so aesthetically it has a better result for the patient.

How long does carpal tunnel surgery take?

In case of the endoscopy Local anesthesia is used. When it is an open surgery, it is applied locoregional anesthesia from the elbow or armpit. This allows for rapid discharge within minutes of completing the intervention.

In any case, the operation should not last more than 20 minutes and since it is an outpatient process, the patient can be home shortly after completing the operation.

Risks of carpal tunnel decompression surgery

The risks associated with the intervention are extremely low. It is very rare to see complications in carpal tunnel surgery, a risk index lower than 1% is calculated.

Possible complications that may arise during and after the procedure include: nerve damage, damage to any of the tendons or postoperative infections.

As for the risks of anesthesia, since it is a local anesthesia, there are no relevant complications that may arise in this regard. Beyond the low risk that exists, it should be noted that all surgical interventions involve risks and, however rare these may be, it is the specialist's obligation to inform the patient of all of them.

Recovery after carpal tunnel surgery

The recovery from endoscopic intervention is very fast Although there are certain essential aspects that must be taken into account to achieve effective rehabilitation:

• Keep your hand elevated for at least a week to reduce swelling.
• Clean and keep the incisions dry to prevent possible sources of infection.
• Avoid sudden movements or lifting weights with your hands during the recovery process.
• Perform hand opening and closing exercises, always prescribed by a professional, to help rehabilitate the area.

The patient may continue to experience some discomfort for a few weeks, so there is no need to worry, but they can expect full recovery of their functions within 2 months.

Preventing carpal tunnel syndrome

Prevention of this syndrome is possible through certain measures that help reduce pressure on the median nerve and prevent cumulative damage. Among the most effective strategies are:

• Take regular breaks during repetitive activities.
• Include stretching exercises to improve flexibility and prevent tension build-up.
• Have an ergonomic workspace.
• Adopt a proper position of hands and wrists when sleeping.
• Strengthen the muscles of the forearm and hand through specific exercises.

It is important to have a professional team of traumatologists of level and experience to guarantee the best treatment. Therefore, if you have any questions you can leave your comment or request your consultation in our trauma clinic in Madrid for a detailed evaluation.