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Open Carpal Tunnel Release

What is Carpal tunnel syndrome

The carpal tunnel is found at the base of the palm. It is formed by the bones of the wrist and the transverse carpal ligament. Increased pressure in the tunnel affects the function of the median nerve.

Carpal tunnel syndrome is a situation in which a nerve is compressed in the wrist. The affected nerve, the median nerve, passes down the forearm in through a tunnel in the wrist. The tunnel is surrounded by bones on three sides and a heavy ligament on the fourth side. The tunnel contains the tendons that make the fingers and thumb to flex down. When it becomes tight in this tunnel either due to acute injury, a culmination of multiple minor injuries, or the effects of normal wear and tear, aging, and possibly arthritis, the nerve begins to dysfunction. This causes tingling or numbness in the thumb, index, and long fingers and perhaps part of the ring finger. It may cause aching in the palm and forearm. In severe cases, the muscles of the thumb will wither and the sensation in the involved fingers will be decreased. In some cases, a specialized test called a nerve conduction velocity is ordered to evaluate for the disease and its severity.

What are the treatment options?

Aspects of median nerve function.

The goal of surgery is to free the ligament to allow more room for the median nerve in the carpal tunnel.

The treatment in all but more severe cases is to wear splints for the wrist that prevent acute flexion and extension. These are usually worn while the patient sleeps so that they do not interfere during their day‑to-day activities. Medications that fight inflammation are also used sometimes.

For failure of conservative measures, surgical options are entertained. The open carpal tunnel release is the traditional method to release the carpal tunnel using an incision on the palm that parallels the ring finger. The incision is usually about an inch and a half long. In this operation the skin is incised, soft tissue is moved aside, and the tight band at the roof of the tunnel is divided. This allows the tunnel to open up. The band heals. The gap that is created after the band is divided and heals creates a larger tunnel for the nerve, reducing the pressure on the nerve.

As with most all hand and upper extremity surgeries, patient compliance with postoperative therapy is key to maximizing results.