Carpal Tunnel Surgery

Carpal Tunnel Surgery

When conservative measures fail, surgery is also an option for a carpal tunnel syndrome with success rates in the 85% to 95% range.  Surgery is done on an outpatient basis under a local anesthetic.  I do it with the anesthesiologist present who can make you as awake as you want or you could also be somewhat sleepy.  In most case, the surgery takes under 10 minutes that involves a small incision in the middle of the palm to release the ligament that extends to the end part of your forearm.  After surgery, you are in a bulky dressing that is on for only two days after surgery.  At that point you will come in to see the therapist who will remove the dressing, placed a lighter dressing, and begin you in an exercise program for you fingers.  Approximately one week after the surgery, you will come back to see me, at which time the sutures will be removed, you can let the incision get wet and start wrist exercises. 

Most of the hand surgery I do is performed on an outpatient basis.  I operate at Saint Raphael's Hospital, The Temple Surgical Center, and Milford Hospital , and Yale.  My secretary, Carolyn, organizes my surgical schedule and will help find the location that works best for the surgery, as well as clearing it with your insurance company.  I feel equally comfortable at all facilities to do surgery.  If you have any questions, please talk to me or my staff.

To assure your understanding, I recommend an appointment in the office to again discuss the surgery, risks and benefits and answer any questions that you have.  You will also see me that day of surgery, so if any questions come up, we will answer them then.  Though the surgery is quite safe, there are risks that do go along with this.  Please see the surgery section. These risks include the risk of anesthetic agents, infection, nerve, vessel, or tendon injury, stiffness, and pain.  Usually, surgery goes very well and the success rate is high but unfortunately, the results of surgery cannot be guaranteed. 

For five to seven days before surgery, you should stop taking Aspirin or anti-inflammatories such as Advil, Aleve, or Motrin unless recommended otherwise by your primary care doctor or cardiologist.  These medications can prolong your bleeding at surgery and can lead to complications and if it is medically safe, you should avoid these medications, Tylenol (Acetaminophen) is perfectly fine.  Unfortunately, the surgical facilities do not tell me until the day before what time your surgery is going to be.  Though you can request with Carolyn the specific time for surgery, unfortunately, this is usually outside of our control.  The facility will tell you the day before surgery where to come and when to come and they will call you to give the details.   

Surgery: As with any surgical procedure, you should not have to eat or drink after midnight the night before but this includes coffee, orange juice, or even water in the morning.  For most surgeries, daily medications prescribed by your regular physician can be taken with a sip of water that morning, but please discuss this with me and my staff if you have any questions. 

Most patients will receive an intravenous dosage of an antibiotic at the time of surgery; this does keep the risk of infection under 1%.  These procedures are considered “clean” procedures and if you have artificial joints or heart valves, the antibiotic that is given at the time of surgery will generally suffice unless the surgeon who implanted your device has told you otherwise.

After surgery, you will leave in a very large bulky dressing that looks like a boxing glove.  When you come to surgery, please wear a loose-fitting garment because the dressing is big.  It is intentionally made this way to help control swelling.  Usually, the therapist will remove it in two days, at which time you will be place in a smaller dressing to begin range of motion.  For a complex surgery, the dressing may stay on for 5 to 10 days, but this will be clearly noted in your postoperative appointment cards.  When you leave surgery, you will have a packet that includes a prescription for pain medication, two appointment cards; one to see the therapist for the dressing and the second to see me for your first check.  You will also be given a series of instruction sheets that is also included in this website, postoperative instructions . 

Two days after the surgery, I encourage you to return as quickly as you can to normal activities using your fingers and a week later, the wrist.  Everyone usually asks “how long does it take to recuperate after the surgery.”  There is no hard and fast answer to this.  As I mentioned, two days after the surgery, I want you to be moving your fingers and a week later, moving your wrist.  I encourage you to return to normal activities as quickly as you can progressively use the hand more and more every day.  Driving is fine once you feel you have control of the car and you are off narcotic medications.  Keyboarding use in  is fine as soon as you start to get comfortable.  Heavy lifting usually takes three to four weeks before that could be restarted. 

The surgery is successful in a vast majority of cases.  There are risks that go along with the surgery, the biggest risk include but are not limited to the risk of anesthesia, infection, nerve, vessel, or tendon injury, recurrent scar tissue, pain, reflex sympathetic dystrophy, (abnormal pain output); these complications occur less than 5% of the time.