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Carpal tunnel release

Procedure description

The median nerve is a nerve which supplies sensation and strength to a portion of the hand.  It passes through the wrist, and is occasionally compressed by a ligament in the wrist known as the carpal tunnel.   Carpal tunnel release is a procedure to decompress the median nerve which runs through the carpal tunnel in the wrist.  Surgery is generally performed using a local anesthetic, along with intravenous sedation.  Once the ligament covering the nerve is divided, and the nerve felt to be free, the wound is closed.  The nerve can take up to 18 months to undergo its full potential of recovery.

Procedure Risks

Carpal tunnel release is a frequently performed surgery.   Risks of the procedure can be broken down into two categories, 1) those related to the operative site, and 2) those related to the risks of anesthesia. 

Risks related to the operative site: 

Surgical Exposure:  The patient is placed in a supine position (on their back).      In this position, there can be pressure sores and  pressure injuries to nerves.   During surgical dissection, injury to muscle, nerves and blood vessels in the area can occur. occur.

Nerve  injuries: If there is any injury to the nerves in the forearm and hand, the consequences may involve loss of sensation, increased burning sensation, paralysis, weakness.   If these is injury to the blood vessels, there could be injury to the survivability of some of the tissues in the hand and forearm. 

General Risks:  These include  general difficulties, such as bleeding, infection, stroke, paralysis, coma and death.  There is also the possibility that the surgery may not relieve the symptoms for which the procedure was performed.  The problem for which the surgery was performed may recur, requiring additional surgery in the future.  In addition, although every attempt is made to protect all areas of the body from pressure on nerves, skin and bones, injuries to these areas can occur, particularly with prolonged cases.

Risks of Anesthesia:
A local anesthetic is generally used.  Blood clots in the legs, heart attacks, reaction to the anesthetic, reaction to blood transfusion, if  given. 

 

Post-operative care:

There shall be no heavy lifting until cleared by the surgeon.  Be patient with the nerve healing.  Numbness may persist for a long time or indefinitely, or it may improve.
 
 The following is a list of suggestions that should help speed your recovery and give you every possible chance for the best results from your surgery.

  1. Immediately upon discharge, contact our office and set up an appointment for staple removal if one has not already been made.
  2. Take it easy until seen by the physician.  This does not mean bed rest, but athletic activities during this period are definitely not recommended.  Please give your incision a chance to heal.  Avoid bending.
  3. Wear your sling if prescribed  by your surgeon.
  4. Lift nothing heavier than a half gallon of milk until seen by your doctor.
  5. Every hour, while awake, wiggle the fingers, and gently squeeze a foam cushion or sponge, if advised by your surgeon.
  6. After you get home, you may begin walking up to one mile per day.
  7. You may walk up or down steps as often as you like.  Please take them smoothly and slowly.
  8. No driving until OK with your physician.    This applies during the first month after surgery.
  9. You may shower after you go home unless otherwise instructed.  Cover the incision with plastic wrap before the shower and remove it afterward.  Change dressing immediately.  Tub baths are not advisable.  You may shower without covering the incision one week after the sutures are out.  Follow instructions concerning care of tape strips, stitches or staples.  Your surgeon or  nurse clinician will explain the techniques used in the closure of your incision.
  10. Sexual activities are permitted.
  11. If you notice swelling, redness or opening of the incision, or if there is any  fluid draining from it, please contact your surgeon immediately!  If you develop a fever, stiff neck or chills, contact the office immediately.  Take your temperature at 4:00 PM daily until the clips are removed.  Call if greater than 101 degrees Fahrenheit.
  12. If you have any questions, call our office, and for after hours emergencies, call the after hours number.
  13. Take your medications prescribed on discharge, as directed.
  14. It takes 6 - 18 months for a nerve to heal.  During that time you may experience numbness, tingling, fleeting pain, or creepy/crawly sensations.
 

 

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