Carpal Tunnel Release (CTS) Surgery in Delhi, India

Carpal tunnel release surgery is a medical procedure designed to alleviate the symptoms of carpal tunnel syndrome (CTS), a condition caused by the compression of the median nerve as it travels through the carpal tunnel (a narrow passageway on the palm side of the wrist). The surgery involves cutting the transverse carpal ligament, which forms the roof of the carpal tunnel. By releasing this ligament, the pressure on the median nerve is reduced, thereby relieving the symptoms of CTS.

Carpal tunnel release surgery is typically performed for the following reasons:

• Severe Symptoms: When symptoms of carpal tunnel syndrome are severe and significantly impact daily activities or sleep, surgery may be recommended. Severe symptoms often include persistent numbness, tingling, and weakness in the hand, as well as loss of manual dexterity and grip strength.
• Non-Surgical Treatments Ineffective: If non-surgical treatments such as wrist splinting, anti-inflammatory medications, corticosteroid injections, and physical therapy do not provide sufficient relief, surgery may be considered.
• Nerve Damage Prevention: In cases where there is a risk of permanent nerve damage, surgery may be necessary to prevent further deterioration. Prolonged compression of the median nerve can lead to permanent loss of sensation and muscle function.
• Chronic Condition: For individuals with chronic CTS that does not improve with conservative management, surgery may offer a more definitive solution.

Overall, carpal tunnel release surgery aims to relieve pain, restore normal hand function, and prevent long-term nerve damage, thereby improving the quality of life for individuals affected by carpal tunnel syndrome.

There are two main types of carpal tunnel release surgery:

Open Carpal Tunnel Release

The surgeon makes a small incision in the palm of the hand near the wrist. The transverse carpal ligament is then cut to relieve pressure on the median nerve.

Advantages

• Direct visualisation of the carpal tunnel, allowing the surgeon to see the structures clearly.
• Often considered more straightforward with fewer technical complications.

Disadvantages

• Longer recovery time compared to endoscopic surgery.
• Larger scar, which may be associated with more post-operative discomfort and a longer healing period.

Endoscopic Carpal Tunnel Release

The surgeon makes a small incision in the wrist and inserts a tiny camera. The surgeon can then see the inside of the wrist on a video monitor and cut the transverse carpal ligament.

Advantages

• Smaller incisions, which typically result in less post-operative pain and scarring.
• Potentially faster recovery and quicker return to normal activities.

Disadvantages

• Higher technical complexity, requiring specialised equipment and training.
• Limited view of the surgical field, which may increase the risk of incomplete ligament release or injury to surrounding structures.

Carpal tunnel release surgery offers several advantages that can significantly improve the quality of life for those suffering from carpal tunnel syndrome.

• Symptom Relief: The surgery significantly reduces or eliminates pain, numbness, and tingling in the hand and fingers, improving hand strength and function.
• Improved Quality of Life: Patients experience enhanced ability to perform daily activities and occupational tasks, along with better sleep quality due to reduced nighttime symptoms.
• Prevention of Further Damage: The procedure reduces the risk of permanent nerve damage and muscle atrophy in the hand.
• High Success Rate: Most patients enjoy long-term relief from carpal tunnel syndrome symptoms.
• Quick Recovery (Especially for Endoscopic Surgery): Many patients return to their normal activities within a few weeks.

Despite its benefits, carpal tunnel release surgery also carries certain risks and potential complications that patients should be aware of before proceeding.

• Infection: There is a risk of infection at the incision site, as with any surgical procedure.
• Nerve or Blood Vessel Damage: There is a small risk of damage to nerves or blood vessels during surgery, which could lead to complications such as increased pain or loss of hand function.
• Incomplete Symptom Relief: In some cases, surgery may not completely relieve symptoms, especially if there is significant nerve damage before the procedure.
• Scarring and Scar Sensitivity: Scarring at the incision site may occur, and some patients may experience sensitivity or pain around the scar.
• Stiffness and Swelling: Temporary stiffness and swelling of the hand and wrist are common post-operative issues.
• Recurrence: Although uncommon, there is a possibility that carpal tunnel syndrome could recur after surgery.
• Reaction to Anesthesia: Patients may experience adverse reactions to anaesthesia used during the procedure.
• Chronic Pain (Rare): Some patients may develop chronic pain in the wrist or hand after surgery, a condition known as complex regional pain syndrome (CRPS).

Preparing for Carpal Tunnel Release Surgery

Preparation for carpal tunnel release surgery involves several steps to ensure the procedure goes smoothly and to optimise recovery. Patients are typically advised to stop taking certain medications, such as blood thinners, a few days before surgery to reduce the risk of bleeding. Pre-operative instructions often include fasting for a certain period before the surgery if general anaesthesia is to be used. It's also important to arrange for someone to drive the patient home after the procedure, as the effects of anaesthesia can impair driving ability. Patients should discuss their medical history and any medications they are taking with their surgeon to avoid potential complications.

During Carpal Tunnel Release Surgery

The procedure begins with the administration of anaesthesia, which may be local, regional, or general, depending on the patient's condition and the surgeon's preference. In open carpal tunnel release surgery, a small incision is made in the palm of the hand to access the transverse carpal ligament. The surgeon then cuts the ligament to release pressure on the median nerve. In endoscopic carpal tunnel release surgery, one or two small incisions are made, and an endoscope is inserted to visualise the ligament, which is then cut using specialised instruments. The incisions are closed with stitches or adhesive strips, and the hand is typically bandaged.

Post Carpal Tunnel Release Surgery Care

After surgery, patients are taken to a recovery area where they are monitored until the effects of anaesthesia wear off. The hand and wrist are usually wrapped in a bandage or splint to keep the area stable and reduce swelling. Pain management is important, and patients may be prescribed pain medications to alleviate discomfort. It's crucial to keep the hand elevated above the heart level as much as possible to minimise swelling. Gentle finger movements are encouraged to prevent stiffness. Stitches are usually removed within one to two weeks, and physical therapy may be recommended to restore strength and flexibility. Full recovery can take several weeks to months, during which patients should avoid heavy lifting or repetitive hand movements. Regular follow-up appointments with the surgeon are necessary to ensure proper healing and to address any concerns.

How long does Carpal Tunnel Release Surgery take? 

Carpal tunnel release surgery typically takes about 15 to 30 minutes to complete, depending on the technique used and the individual patient's anatomy.

Will I need to stay overnight in the hospital? 

Most carpal tunnel release surgeries are performed on an outpatient basis, meaning you can go home the same day. However, in rare cases, an overnight stay may be required for observation.

Which anaesthesia option is typically used for carpal tunnel release surgery 

Local anaesthesia is commonly used for carpal tunnel release surgery to numb the hand and wrist area. In some cases, regional or general anaesthesia may be administered based on patient needs and surgeon recommendations.

How soon can I return to work after the surgery? 

The timeline for returning to work varies depending on the nature of your job and the type of surgery performed. Office workers may return to light duties within a few days to a week, while those with physically demanding jobs may need several weeks to recover.

Will I need physical therapy after surgery?

Physical therapy is often recommended to help restore strength and flexibility in the hand and wrist, especially if you had severe symptoms before surgery or if your recovery is slower than expected.

Can carpal tunnel syndrome recur after surgery?

While carpal tunnel syndrome can recur, it is relatively uncommon. Following post-operative care instructions and making ergonomic adjustments in daily activities can help minimise the risk of recurrence.

What can I do to prevent carpal tunnel syndrome after surgery?

Preventive measures include maintaining proper wrist posture, using ergonomic tools and workstations, taking regular breaks from repetitive tasks, and performing hand and wrist exercises to strengthen the muscles.

How much pain should I expect after the surgery?

Post-operative pain varies among individuals but is generally manageable with prescribed pain medications. Most patients experience significant pain relief within a few days to weeks after the surgery.

Will I have a scar after the surgery?

Both open and endoscopic carpal tunnel release surgeries will leave a small scar. The size and visibility of the scar depend on the surgical technique used. Scars typically fade over time.

Are there any long-term restrictions after the surgery?

Most patients can resume their normal activities without long-term restrictions after fully recovering from carpal tunnel release surgery. However, it's essential to follow your surgeon's advice on activity limitations during the recovery period to ensure optimal healing.

Reviewed By Dr Vikas Gupta, Director - Orthopaedics and Head - Hand & Shoulder Surgery on 19 July 2024.