Endoscopic Carpal Tunnel Release Surgery

What happens during carpal tunnel treatment?

Diagnosis before carpal tunnel surgery

During the physical exam for carpal tunnel syndrome, your doctor will ask you questions about your symptoms, medical history, occupation, and general health. Your affected hand and wrist will be carefully examined with the help of several tests. During the tests, the doctor may do one or all of the following things. 

• Tap along or press down the median nerve at the inside of your wrist to see if any numbness or tingling is caused. 
• Bend and hold your wrist in a flexed position to check for tingling and numbness in your hand.
• Lightly touch your fingers with a special instrument when your eyes are closed to check the sensitivity in your fingertips
• Check for muscle atrophy at the base of your thumb
• Check for the weakness of the muscles at the base of your thumb

After a physical exam, some tests are performed to ascertain the extent of the condition and the damage to the median nerve. Some of the tests that may be performed and listed as follows:

• Nerve conduction test: A nerve conduction test measures the signals that transmit in your nerves. This test can detect if your median nerve is not conducting its signal properly and can help your doctor to a certain extent of median nerve damage. 
• Electromyogram or an EMG: An electromyogram measures the electrical activity in the muscle and shows the extent of muscle and nerve damage.
• X-rays:  X-rays are perfect for obtaining images of dense structures like bones. If you have limited function of the wrist and experience pain in movements, your doctor can order an x-ray to exclude any other causes for your symptoms like arthritis, fracture, or ligament injury.
• Magnetic resonance imaging or an MRI: MRI scans provide a better image of soft tissues. An MRI can help your doctor to determine any other causes for your condition and can help him look for abnormal tissues which might be affecting the median nerve. It can also help the doctor to determine if there are any problems with the nerve itself, like an injury, tumor, or scarring. 

Procedure for carpal tunnel surgery

The surgery is minimally invasive and aims to release the pressure on the median nerve. The surgery makes use of an endoscope, which involves a flexible, thin tube that has a camera attached at its end. A small incision is made on the risk and the endoscope is inserted through it. This helps the surgeon to visualize the internal structure without a large incision. When the ligament is located, a tiny cutting tool is inserted to release the ligament. This, in turn, releases the pressure on the median nerve and eliminates the symptoms of carpal tunnel syndrome.

How to prepare for carpal tunnel surgery?

You must keep yourself prepared for carpal tunnel release surgery. The following are a few tips that can help you prepare better.

• Answer all questions of your doctor diligently and carefully. Make sure you don’t forget any details.
• Get the preoperative testing done in time. Preoperative tests depend on our health, age, condition, and the severity of the technique of the surgery and help to identify any concerning factors before surgery.
• Follow the diet chart given to you by your doctor before surgery.
• Follow the instructions regarding medications as told by your doctor before surgery.

Discuss with your orthopedic surgeon about all medicines you are at that moment, including OTC medicines, supplements, vitamins, and herbs. You will probably be asked to stop taking certain medicines, such as ibuprofen or aspirin, before the surgery.

If you are a smoker, you will be advised to quit before the surgery as smoking can delay healing. You might be asked not to eat or drink anything for 6-12 hours before the surgery.

Based on your medical condition and history your orthopedic surgeon may request other specific preoperative preparations. You may need to undergo certain preoperative tests such as blood tests or an electrocardiogram (ECG) before the surgery. This usually happens on the same day of the surgery.

What happens if carpal tunnel syndrome is left untreated?

Delaying or avoiding surgery for carpal tunnel release can worsen the severity of the condition and you may experience a progression of the current symptoms and may experience severe pain and reduced hand motion. Patients are suggested to have surgery for carpal tunnel syndrome as soon as possible to prevent further deterioration. To consult our orthopedic surgeons for carpal tunnel syndrome near you, give us a call to make an appointment at our orthopedic clinic in your city. 

Physiotherapy for carpal tunnel surgery

After carpal tunnel release surgery, if the patient does not follow proper rehabilitation and physiotherapy, then the recovery will take much longer. Physiotherapy helps avoid the build-up of scar tissue in the operated region and opens up the tunnel in the wrist to allow proper wrist function. It also helps regain a complete range of motion for the wrist. In addition to physiotherapy, patients should also wear assistive devices such as thumb splints to encourage recovery.

Common carpal tunnel syndrome exercises to follow after carpal tunnel surgery are:

-Finger tip touching: Hold up your hand, palm side up, and touch your thumb with each fingertip in both directions to complete a full cycle. Perform this exercise 3 to 5 times.

-Wrist flexion and stretch: Extend your arm with the wrist flexed at a 900 angle. Pull the wrist back by the other hand. Hold this position for 10-30 seconds 5-6 times for each hand.

–Tendon gliding: Hold your hand straight up and bend your fingers at a 900 angle towards the first knuckle while keeping the fingers together. Then, bend them towards the second knuckle, then form a fist. Then open the hand and repeat the action 5-10 times.

What are the major risk factors associated with carpal tunnel syndrome?

Risk factors associated with carpal tunnel syndrome are:-

People with small carpal tunnels hereditarily are more likely to get carpal tunnel syndrome.

Women are three times more likely to get carpal tunnel syndrome, especially during pregnancy due to constant hormonal fluctuations.;

• Patients between the ages of 40 and 70.
• Wrist injury including sprained and fractured wrists.
• Frequent exposure of hands to extreme temperatures.
• Medical conditions such as overactive pituitary gland, hypothyroidism, rheumatoid arthritis, diabetes, etc.
• A delayed complication of improperly managed Colles’ fracture. 
• Repetitive movements of hands or wrists.

Post-operative care and rehabilitation

After carpal tunnel surgery, most patients are discharged on the same day. At the time of discharge, patients are given some instructions for rehabilitation and post-operative care. The instructions may include the following.

• Use of a splint for a few weeks.
• Elevation of hands and use of ice packs to reduce swelling and inflammation.
• Regular cleaning of the surgical incision.
• Practice a healthy diet to help the healing process along.
• Physiotherapy for restoration of normal function

Case Study

Ms. Manisha Chauhan (changed name) contacted Pristyn Care through our website by filling out the form with the required details. He was suffering from pain, numbness, and discomfort in her left wrist. Our medical coordinator booked her appointment with Dr. Pono Goti Vamshi Bharat.

Dr. Bharat conducted a physical examination to check the severity of the condition. He even recommended a few diagnostic tests such as nerve conduction study(NCS) and electromyography (EMG). After getting the results, Dr. Bharat diagnosed Ms. Chauhan with stage 2 carpal tunnel syndrome. He recommended endoscopic carpal tunnel release surgery to treat the condition. 

The surgery was performed on an outpatient basis. She got discharged the same day of the surgery as it was successful. Dr. Bharat scheduled a follow-up consultation after a week of surgery to check the progress of the recovery. 

She informed later in follow-up session that she is recovering well and not feeling any pain or other symptoms in her left hand.