Surgery entails cutting or transecting the transverse carpal ligaments that overlies the median nerve and can be done as an outpatient basis or a day care procedure in the OT.
The surgery itself can be accomplished in two ways:
The traditional approach is by open carpal tunnel surgery, whereby a longitudinal skin incision is made in the wrist and the carpal ligament cut to relieve the pressure on the median nerve. Incisions generally have become smaller over the years, and the so-called "mini" 2cm skin incision have become the standard length now.
Surgery takes about 20 minutes and can be done under local anaesthesia although my preference is to do it under general anaesthesia, unless there are contraindications.
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| Torniquet applied to prevent bleeding |
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| Local anaesthesia injected |
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| Checking for the landmarks |
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| Incision over the wrist |
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| Incision deepened |
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| The carpal ligament is cut |
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| The underlying median nerve could be seen |
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| Wound washed and closed |
Post operatively, the patient will feel relief from the night pain, as early as the day after surgery. Numbness of the fingers will take a bit more time to disappear, as is wasting of the hand muscles which will be the last to recover.
Sutures are usually taken off at two weeks and patients are advised not to lift heavy objects or to grip tightly for the next 4-6 weeks. There might be some weakness of the hand grip but this will also recover over time.
Another, more minimally invasive method would be through the endoscopic method. A small incision is made at the wrist and a small camera, together with a knife, introduced into the wound to see the carpal tunnel. The ligament is then cut below the skin by the knife. Proponents of this technique claim shorter recovery time and less post operative pain. The downside is the complexity of the procedure as it necessitates more (expensive) equipment and has a steeper learning curve on the part of the surgeon.
- the BOMOH TULANG -
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