Type of Surgery

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Last updated: 11/24/2009

Risks

All surgical procedures involve some risk of infection through the operated site. Sharing all pertinent past and present medical history with the surgical team helps to lower the chance of a complication. In addition to the risk of the surgery...

itself, there are the risks associated with anesthesia. In carpal tunnel release surgery, anesthesia is more localized, which lowers the chance of complications. Nonetheless, it is important to share with the anesthesia team the list of all the vitamins, herbs, and supplements, over-the-counter medications, and prescription medications that the patient is taking. Drug interactions can be significant, especially if the anesthesia team does not have all the necessary information to make the best anesthesia choices for a particular patient. Complications such as nerve damage are linked with poor surgical technique.


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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.

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To perform a carpal tunnel release, the surgeon makes an incision in the palm of the hand, above the area of the carpal tunnel (B). The carpal ligament going across the hand is severed (C), releasing pressure on the median nerve (D). (Illustration by GGS Inc.) To perform a carpal tunnel release, the surgeon makes an incision in the palm of the hand, above the area of the carpal tunnel (B). The carpal ligament going across the hand is severed (C), releasing pressure on the median nerve (D). (Illustration by GGS Inc.)




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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.

Procedure

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.


From http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#Carpal_tunnel_release_surgery

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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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