Carpal tunnel surgery
What is carpal tunnel syndrome?
Carpal tunnel syndrome is compression of the median nerve. This nerve passes through your wrist and into the palm of your hand where it branches out to provide sensitivity to the palmar surface of the first 3 fingers and part of the 4th. It also ensures the motor innervation of certain muscles of the thumb. The carpal tunnel remains a closed and inextensible channel; this is why the Median nerve is exposed to different causes of compression (bone narrowing of the canal, synovitis, vascular malformations, increased intracarpal pressure).
This carpal tunnel syndrome is very common in the general population, particularly during pregnancy and in women from the age of 50. It is also found to be more frequently affected in manual workers.
Compression of the median nerve results in tingling, numbness, and sometimes pain in the thumb, index, and middle fingers. In principle, these sensitivity disorders only affect the fingers. The pain concerns the fingers but can extend to the whole hand and even go up the arm to the shoulder.
These painful phenomena and tingling usually occur at night. They cause awakenings and the symptomatology decreases when shaking the hand. The involvement can be bilateral.
The diagnosis is made by electromyogram (EMG). It detects very precisely the compression, its level, its severity and therefore its prognosis.
Why an operation?
Infiltration can sometimes be performed as a first-line treatment in the event of moderate damage, but if the damage is pronounced, it is better to resort to surgery as soon as possible because the recurrence of the symptoms will be inevitable.
The intervention consists of a release of the median nerve which suffers and weakens by compression. Only this surgical release is likely to allow the return to normal with a disappearance of pain and tingling. Of course, the more the nerve has suffered and the longer the compression, the less the chances of complete recovery without sequelae.
The intervention must therefore be done quickly in the event of fixed symptoms to avoid axonal degeneration and severe muscle damage.
Process of the intervention
The intervention is done under endoscopy, with local anesthesia and in outpatient surgery.
It consists, by a mini-approach located in the palmar flexion crease, in sectioning under endoscopic control the flexor retinaculum to release the compressed median nerve
The procedure lasts an average of 10 minutes.
It offers the advantages of the endoscopic technique:
Small and invisible incision because located in the flexion crease.
Less painful post-operative phenomena.
Faster mobility recovery.
Best end result on strength recovery.
Operative follow-up
They are generally simple even if sometimes some sensory disturbances persist which will gradually disappear. Exit is authorized the same day of the intervention.
Gentle and progressive finger and wrist mobilization can be immediately achieved.
Bandages are to be done at home every 2 days by a nurse.
The prescribed analgesic and anti-inflammatory treatment must be taken systematically.
The risks and complications
A hematoma can occur immediately following the operation. If it presents a compressive nature for the median nerve, surgical evacuation would be desirable.
An infection remains exceptional; it generally remains localized to the approach and requires local care.
A partial or total lesion of the Median nerve can occur during the intervention and secondarily require a nerve suture. Fortunately, this complication remains quite rare.
Finally, it is more common to encounter some small persistent sensory disturbances after surgical release. They are correlated with the preoperative damage to the median nerve. Recovery usually takes several months.
The risks listed above do not constitute a completely exhaustive list. Your surgeon will give you all the necessary additional explanations and will be at your disposal to discuss each particular case with you.
The expected results
The pain disappears instantly as well as the majority of tingling. However, if the nerve has remained compressed for too long, the tingling may last very mildly for several months.
Professional activities can be after 3 weeks in the event of minimal stress on your hand. It takes 5 to 6 weeks in case of intensive manual work.
Recovery is complete in almost all cases since this surgery is credited with 97% of good and very good results.