Carpal Tunnel Decompression

About the Procedure

Carpal tunnel release (CTR) surgery is a procedure designed to treat patients suffering from hand pain associated with Carpal Tunnel Syndrome (CTS). This pain is the direct result of pressure being exerted upon the median nerve by the transverse carpal ligament (TCL). This pressure causes pain and numbness in the thumb and fingers, making many daily activities difficult, or in some cases, nearly impossible. The goal of CTR surgery is to relieve the pressure being put on the median nerve.

CTR surgery is performed under local anesthesia and can be done using an “open” or minimally invasive method. Currently, no conclusive evidence exists to suggest that one method is empirically better than the other. Both have pros and cons to consider.

In the open methodology, a large lateral incision is made across the bottom of the patient's palm in order to grant the surgeon access to the transverse carpal ligament. Then a vertical incision is made on the TCL where it covers the median nerve. This results in the median nerve being completely unencumbered. The lateral incision of the palm is then closed up with stitches, completing the surgery.

The minimally invasive variant, Endoscopic Carpal Tunnel Release (ECTR) surgery is different in that the initial incision is much smaller. Once the small incision is made, a narrow, flexible tube with a tiny fiber optic camera (called an endoscope) is inserted, affording the surgeon vision of the surgical site. Then, using small instruments designed to fit through the tiny incision, the surgeon cuts the TCL just as in the open method. The small surgical incision is then closed.

What to Know Before the Procedure

Before deciding to have surgery, talk to your doctor about non-surgical treatments for CTS. In most cases, if it is detected early, non-surgical treatments have shown very high levels of success. CTR surgery is quite simple and safe, and has a high success rate, but it should be reserved as a last resort after non-surgical options have proved ineffective.

Open CTR and ECTR procedures carry different risks, side effects and recovery times but are generally similar in cost. The main benefit of ECTR is the faster recovery time and the fact that most patients report less pain than the open variation. Discuss with your doctor which method is best for you.

What to Know After the Procedure

Patients undergoing this surgery generally go home the same day. Your hand will be put in a soft cast to protect the stitches. It is recommended to avoid activities that put heavy stress on your hand for around 3 months. Normal, everyday activities can be resumed anywhere between two days to two weeks after the surgery.

Though many people feel the positive effects of the surgery within a couple of days, it may take several weeks before your CTS symptoms completely fade. Due to the cutting of the TCL, you may find that your gripping strength is compromised. This is common and not cause for alarm. With physical therapy, this can be improved but your hand strength may never return to pre-operative levels.

If you Need to Travel Outside of your Local Hospital

The overall cost of this surgery is relatively low and it does not present any significant challenges during travel. As such, the most important factor in your travel decision is the level of experience of your surgeon, and how comfortable you feel with them. As with any surgery, volume and experience should be major considerations when deciding on a surgeon. There are highly qualified candidates for performing this procedure around the world.