Type of Surgery
Last updated: 11/24/2009
Initial postoperative care while the individual is still in the surgical center involves making sure that circulation in the hands and fingers has not been compromised. There should be a strong radial (wrist) pulse, and the fingers should be...
their normal skin color and warm to the touch. The individual should be able to move all fingers equally, and there should be no edema.
Once discharged, it will be important for the patient to be aware of signs of complications. Contact the surgeon with symptoms such as:
- pale or bluish color to the operated hand
- if the operated hand feels significantly colder than the non-operated hand
- inability or difficulty moving the fingers in the operated hand
- numbness in the operated hand
- bleeding from the bandaged hand
- swelling of the operated arm
A splint may be worn for about a month to help keep the wrist in a neutral position. This may be followed by exercises to both stretch and strengthen the hand, fingers, and wrist. Any accommodations in the work or home environment will need to be made to prevent further problems.
A journalistic report on a woman's experience with carpal tunnel syndrome and how she found relief with a new endoscopic carpal tunnel release surgery.
Carpal tunnel release surgery
Release of the transverse carpal ligament ("carpal tunnel release" surgery) is recommended when there is static (everpresent, not just intermittent numbness), weakness of palmar abduction, or atrophy, and when night-splinting no longer controls intermittent symptoms. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and are likely to result in surgical treatment.
In carpal tunnel release surgery, the goal is to divide the transverse carpal ligament in two. This is a wide ligament that runs across the hand, from the base of the thumb to the base of the fifth finger. It also forms the top of the carpal tunnel, and when the surgeon cuts across it (i.e., in a line with the middle finger) it no longer presses down on the nerves inside, relieving the pressure.
There are several carpal tunnel release surgery variations: each surgeon has differences of preference based on their personal beliefs and experience. All techniques have several things in common, involving brief outpatient procedures; palm or wrist incision(s); and cutting of the transverse carpal ligament.
The two major types of surgery are open-hand surgery and endoscopic surgery. Most surgeons perform open surgery, widely considered to be the gold standard (test). However, many surgeons are now performing endoscopic techniques. Open surgery involves a small incision somewhere on the palm about an inch or two in length. Through this the ligament can be directly visualized and divided with relative safety. Endoscopic techniques involve one or two smaller incisions (less than half inch each) through which instrumentation is introduced including probes, knives and the scope used to visualize the operative field.
All of the surgical options typically have relatively rapid recovery profiles (days to weeks depending on the activity and technique), and all usually leave a cosmetically insignificant scar.
New procedures like minimally invasive procedures are often subject to scrutiny, but I think that one of the biggest problems facing these innovative procedures is for people to understand exactly what we do.
-Dr. Michael Perry, Laser Spine institute
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