Can Carpal Tunnel Come Back After Surgery
If you’re reading this article, chances are you’ve been diagnosed with carpal tunnel syndrome (CTS), or may have a loved one who has it. The bad news is that CTS can be very painful and debilitating, but the good news is that if caught early enough, surgery can help relieve some of those symptoms. And while there’s no guarantee that your wrist pain will go away after surgery, most experts say that the odds of experiencing any post-op complications are low. According to the Cleveland Clinic Foundation, less than 5 percent of people who undergo carpal tunnel release surgeries suffer from recurrence of the condition.
Carpal tunnel is an area in which the median nerve — the largest nerve in your body — runs through a narrow passageway between two bones called the carpus. This passageway gets its name from the Latin word carpa, meaning “hand.” When narrowed due to pressure from surrounding tissue structures, such as muscles, tendons and ligaments, the result is carpal tunnel syndrome. People typically develop symptoms such as tingling, burning and numbness on the thumb side of their hand and/or fingers. Other symptoms include weakness or tightness in the affected hand and trouble doing repetitive tasks. It’s estimated that about 2 million Americans suffer from CTS.
So how does carpal tunnel actually occur? First, because our hand uses so many different movements, our hands get a lot of use. We grip, pinch, rotate, flex, extend and turn our wrists frequently throughout each day, possibly putting undue stress on the median nerves. In addition, we also hold objects close to our bodies, which puts further strain on our hands and wrists. All of these actions put additional pressure on the median nerves, causing them to become inflamed and irritated over time.
Once the nerves start to swell up, they begin to cause problems by sending inaccurate signals to the brain. As a result, the muscles involved in performing certain functions tighten up, making it difficult to move our fingers and thumbs properly. Eventually, the muscles at the base of our thumb and index finger stiffen up, which makes it harder to bend these digits into various shapes.
In order to treat CTS effectively, doctors must determine exactly what type of carpal tunnel problem the patient has. If he or she suffers from a simple form of CTS, where the median nerve is only mildly compressed, then noninvasive treatments like massage therapy might provide relief. But if the compression is severe or caused by another issue, such as a tumor, rheumatoid arthritis or trauma, then surgical intervention may be necessary.
There are three types of procedures used to correct carpal tunnel issues: open carpal tunnel release, endoscopic carpal tunnel release and minimally invasive carpal tunnel release. Each one involves cutting out part of the carpal bone and stretching the carpal ligament so that the median nerve can once again function freely.
Open carpal tunnel release is the most common procedure for relieving carpal tunnel pressure. During this surgery, a small cut is made under the skin on the palm side of the hand. Then, using a special tool, the doctor cuts and pulls apart the transverse carpal ligament. Next, the doctor removes some of the soft tissues around the wrist joint to prevent scarring and adhesions. Finally, the skin is sutured together and staples are placed along the edges to keep the wound closed. Patients usually need to take several weeks off work following surgery, and they should avoid strenuous activity and wear splints during recovery.
Endoscopic carpal tunnel release is similar to open carpal tunnel release except instead of making a large incision, the surgeon inserts a long tube with a tiny camera attached at the tip down inside the wrist. Once inserted, the tube allows the doctor to perform all four steps mentioned above without having to make a larger cut. Minimally invasive carpal tunnel release requires inserting a thin instrument through just a few inches beneath the skin rather than cutting a much bigger hole. Doctors do not remove any tissue during this process, and therefore patients don’t have to spend extra days recovering after the surgery.
While both kinds of surgeries can alleviate some of the pain associated with carpal tunnel, they don’t always eliminate other symptoms completely. For example, even though the majority of patients report feeling better right after surgery, more than half of them complain of lingering pains in their hands. These residual pains could last anywhere from six months to years, depending on the severity of the initial injury. Fortunately, new research suggests that there are ways to reduce the frequency of post-operative discomfort. Specifically, scientists found that pre-warming the operating table surface before placing the patient’s hand on top of it reduces post-procedure discomfort. So if you plan on undergoing a carpal tunnel operation, consider asking your doctor to warm the table first!
For more information on treating carpal tunnel syndrome, please see the next page.
Treating Carpal Tunnel Syndrome
After deciding whether to undergo surgery for carpal tunnel, patients often wonder how soon they’ll return to normal activities. Unfortunately, there’s no hard-and-fast rule regarding when patients should resume working and daily routines. Most surgeons recommend waiting until the swelling subsides before returning to everyday life. Also, since the average age of someone suffering from carpal tunnel is 40, the typical patient isn’t going to rush back into high-stress situations immediately after surgery. Instead, they should gradually increase the amount of physical activity they participate in over time.
Patients also want to know how quickly they should expect to feel better afterward. While it varies from person to person, most patients recover within a week or two, although some cases can take longer. Since the length of healing depends largely upon how well the injured area was cared for prior to surgery, patients who received care from experienced medical professionals have a lower chance of developing infections and other complications.
Although the vast majority of patients who undergo carpal tunnel operations experience positive results, there’s a possibility of negative outcomes after the surgery. One potential risk is damage to nearby blood vessels. Another is nerve injuries, especially ones that affect sensation. Thankfully, both of these risks are rare; however, if they occur, they usually happen during the opening of the carpal ligament. To protect yourself against these possibilities, ask your physician about his personal experiences with similar procedures. He or she probably won’t share this information with everyone, but you should be aware that not every doctor performs carpal tunnel operations perfectly.
To learn more about carpal tunnel surgery and related topics, check out the links on the following page.
Because doctors don’t fully understand why some patients develop recurrent carpal tunnel, they sometimes offer preventive treatment to people at higher risk of future episodes. For instance, women who already have children are sometimes given routine mammograms to look for tumors in the breast. Men whose fathers had prostate cancer are screened regularly for the disease as well. There are also tests available to detect genetic mutations linked to carpal tunnel in men and women.
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