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General information: Carpal Tunnel Decompression is a standard procedure for treatment of median nerve compression when it passes under the transverse carpal ligament at the wrist joint.
Target and results: Although the results of surgery are generally good in term of preventing of further neurological progression of the condition, recovery of the existing symptoms may not possible. Numbness and tingling may improve quickly or slowly. It may take many months for recovery after surgery. Carpal tunnel symptoms may not totally go away after surgery, especially if symptoms are severe.
Risk of complications:
- Infection is less than 2 percent. It may affect the superficial tissues and skin, or may affect deep structures around the nerve and the tendons of the muscles in the hand which is very rare.
- Bleeding which may lead to hematoma collection that needs further surgery.
- Neural tissue injury: the most serious complication may cause life changing consequences in form of weakness or paralysis of hand muscles leading to loss of hand grip or sensor changes. The risk is very small, <1%.
- Failure to improve symptoms with progression of the condition which is related to nerve damage and scarring which would unlikely respond to surgery.
- General anesthetic complications (heart attack, stroke), local anesthetic allergic reaction.
- Deep venous thrombosis/pulmonary embolism (clots in legs / lungs) in cases of general anesthesia surgery.
Procedure:
Carpal Tunnel decompression is a standard procedure that is carried out on routine base. The procedure is usually done under local anesthesia, unless the patient requests general anesthesia. It lasts approximately 30 minutes. The patient is usually kept awake; local anesthetic infiltration is the only painful step in the procedure. During the procedure, the surgeon will communicate with the patient, if feels any pain or discomfort, further infiltration of the LA will be done. It involves making 5 cm midline incision at midline hand crease, dissection to expose the nerve under the transverse carpal ligament. The target is freeing the nerve proximally under the proximal wrist creases and distally until it completely free.
The wound is closed in layers with dissolvable stitches; skin is closed with Nylon stitches which need to be removed in 10 days. Most patients will go home after 2-4 hours and will be recovering at home for approximately 4 weeks. Patient should avoid heavy weight lifting and heavy physical activity for 4 weeks. Following surgery the patient may notice some pain and stiffness but this should settle with simple pain killers. Specialist hand physiotherapists will advice each patient on a postoperative exercise regime, to encourage movements. Continuous fingers movement is advisable. Further outpatient physiotherapy sessions will be offered, where indicated. Patient is usually followed up in the clinic in 8-12 weeks after surgery. If any complication happens, the patient will stay until everything gets sorted. All regular medication will continue except the blood thinning medication like Warfarin, Apixoban, Aspirin, cloidogrel etc, needs advised individually. Most of the cases can started after 48h from the surgery.