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Carpal Tunnel Decompression

Last updated March 31, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Carpal Tunnel Decompression procedure involves relieving pressure on the median nerve in the wrist by cutting a band of tissue. This helps to alleviate pain and other functional symptoms of carpal tunnel syndrome.

Background Information:

What are the other Names for the Procedure?

  • Decompression Surgery for Carpal Tunnel Syndrome

What is the Carpal Tunnel Decompression surgical procedure?

  • Carpal Tunnel Decompression procedure involves relieving pressure on the median nerve in the wrist by cutting a band of tissue
  • This helps to alleviate pain and other functional symptoms of carpal tunnel syndrome

What part of the Body does the Procedure involve?

Carpal Tunnel Decompression surgical procedure involves the fibrous tissues in the wrist and palm of the affected hand.

Why is the Carpal Tunnel Decompression surgical procedure Performed?

Carpal Tunnel Decompression surgical procedure is performed for carpal tunnel syndrome, which is a disorder characterized by pain, numbness or tingling in the hand due to a compression of the median nerve that runs into the hand under a band of tissue at the wrist. The disorder does not respond to conservative treatment measures with pain medication and splints.

What are some Alternative Choices for the Procedure?

Use of wrist splints and corticosteroid injections may be used to relieve symptoms. Usually, there are no alternatives to surgery once conservative treatments measures have failed in treating carpal tunnel syndrome.

What are the Recent Advances in the Procedure?

In some cases, a keyhole surgery using smaller skin incisions may be done using specialized instruments and a tube fitted with a camera.

What is the Cost of performing the Carpal Tunnel Decompression surgical procedure?

The cost of Carpal Tunnel Decompression procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

It is normal for a patient to feel uncomfortable and confused by the information regarding an Carpal Tunnel Decompression procedure and on what needs to be done

If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required

Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.nhs.uk/Conditions/Carpal-tunnel-syndrome/Pages/Treatment.aspx (accessed on 05/17/2015)

http://www.carpal-tunnel.net/treatments/surgery (accessed on 05/17/2015)

Prior to Carpal Tunnel Decompression surgical procedure:

How is the Carpal Tunnel Decompression surgical procedure Performed?

The Carpal Tunnel Decompression procedure may be performed under local anesthesia with/without sedation.

  • The surgeon makes an incision on the wrist of the affected hand
  • The pressure on the median nerve is relieved by cutting a band of fibrous tissue that lies over the nerve
  • The skin incision is then sutured

Where is the Procedure Performed?

A Carpal Tunnel Decompression procedure is usually performed in a hospital as an outpatient procedure.

Who Performs the Procedure?

The procedure is performed by any of the following medical personnel, with or without assistance from an anesthesiologist:

  • A neurosurgeon
  • An orthopedic surgeon

How long will the Procedure take?

The procedure may be completed in less than half an hour.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Carpal Tunnel Decompression procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Carpal Tunnel Decompression procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the  Carpal Tunnel Decompression surgical procedure?

Before a Carpal Tunnel Decompression procedure, the patient has to undergo certain tests such as:

  • Routine blood and urine analysis
  • Other tests as directed by the healthcare provider

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Carpal Tunnel Decompression surgical procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • What are the costs involved?

During the Carpal Tunnel Decompression surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection and sedation by injection is administered for this procedure.

How much Blood will you lose, during the Procedure?

The blood loss during an uncomplicated Carpal Tunnel Decompression procedure is not significant.

What are the possible Risks and Complications during the Carpal Tunnel Decompression surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
  • Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders and chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Carpal Tunnel Decompression surgery are:

  • Infection within the surgical wound
  • Bleeding
  • Accidental injury to the nerve

What Post-Operative Care is needed at the Healthcare Facility after the Carpal Tunnel Decompression surgical procedure?

Usually no specific post-operative care is required after the procedure. Patients are usually discharged from the hospital the same day as the procedure.

After the Carpal Tunnel Decompression surgical procedure:

What are the possible Risks and Complications after the Carpal Tunnel Decompression surgical procedure?

The possible risks and complications that may arise after a Carpal Tunnel Decompression procedure are:

  • Infection within surgical wound
  • Scarring
  • Persistent symptoms

What is the Prognosis after the Surgery?

The prognosis after a Carpal Tunnel Decompression procedure is generally good. The surgery helps in symptom relief in a vast majority of individuals.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Worsening pain and swelling around the surgical wound
  • Bleeding or fluid drainage from the surgical wound
  • The occurrence of any symptom that causes uneasiness such as nausea, vomiting, abdominal swelling, or constipation
  • Signs of an infection
  • Headache, muscle aches
  • Fever, feeling sick
  • Dizziness
  • Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Carpal Tunnel Decompression surgical procedure?

At home, the following post-operative care is recommended, after a Carpal Tunnel Decompression procedure:

  • Slowly resume regular/daily activities as early as possible, which aids in faster recovery
  • Use a heat pad or warm compress to relieve pain due to the incision
  • It may be necessary to keep the operated hand elevated for a day or two to minimize swelling. A hand bandage may have to be worn for 2-4 days after the surgery
  • Physical therapy and finger and wrist exercises should be done as advised
  • Avoid lifting of heavy weights
  • Avoid driving for a few days after the procedure, as advised by your physician
  • Showering may be resumed after surgery provided the wound is kept bandaged, clean and dry. Avoid taking baths until the surgical wound is completely healed
  • Complete the course of prescribed medication under advice of the physician
  • Take antibiotic medication to help combat or prevent infection, per your physician’s advice
  • Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain (per the physician’s advice)

How long does it normally take to fully recover, from the Procedure?

Complete recovery from the procedure may take a few weeks.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Any tissue that is removed is disposed as per standard medical procedures. However, in some cases, the surgeon may recommend a pathological examination of the tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Usually, a pathologist does not get involved in the care of the patient. However, if a tissue is received for further lab analysis, then:

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Carpal Tunnel Decompression surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • A hospital
  • An anesthesiologist (if anesthesia was administered)
  • An orthopedic surgeon/ neurosurgeon
  • A pathologist (if tissue is sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Carpal Tunnel Decompression procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 28, 2015
Last updated: March 31, 2018