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Carpal Tunnel

In treating carpal tunnel syndrome, surgery may be required to release the compressed median nerve. The open release procedure involves simply cutting the transverse carpal ligament.

The Mini-Open Approach. In recent years, more surgeons have adopted a “mini” open — also called short-incision — procedure. This surgery requires only a one-inch incision, but it still allows a direct view of the area (unlike endoscopy, which is viewed on a monitor). The mini-open approach may allow for quicker recovery while avoiding some of the complications of endoscopy, although few studies have investigated its benefits and risks. The recovery time in patients receiving the mini-open approach may be shorter than with the open approach, and results are generally the same.

If you have open carpal tunnel release surgery, you usually do not need to stay in the hospital. It is usually done under local anesthetic and you can go home on the same day.

Why It Is Done

Open carpal tunnel surgery is considered when:

• Symptoms are still present after a long period of nonsurgical treatment. In general, surgery is not considered until after 3 to 12 months of non-surgical treatment. But this assumes that you are having ongoing symptoms but no sign of nerve damage. Nerve damage would make surgery more urgent.
• Severe symptoms (such as persistent loss of feeling or coordination in the fingers or hand, or no strength in the thumb) restrict normal daily activities.
• There is damage to the median nerve (shown by nerve test results and loss of hand or finger function), or a risk of nerve damage.
• Tumors or other growths need to be removed.

How Well It Works

Most people who have surgery for carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their hand after surgery. More than 70 out of 100 people are satisfied with their results, and as many as 90 out of 100 people have no night pain after surgery.

In rare cases, the symptoms of pain and numbness may return (the most common complication), or there may be temporary loss of strength when pinching or gripping an object, due to the cutting of the transverse carpal ligament.

If the thumb muscles have been severely weakened or wasted away, hand strength and function may be limited even after surgery.

Citations

1. Katz JM, Simmons BP (2002). Carpal tunnel syndrome. New England Journal of Medicine, 346(23): 1807–1812.
2. Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).
3. Ashworth N (2007). Carpal tunnel syndrome, search date December 2006. Online version of BMJ Clinical Evidence.

Sources:
Web MD : Author: Shannon Erstad, MBA/MPH
University of Maryland Medical Center

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