Carpal Tunnel Surgery and Lymphedema
Lymphedema Preoperative Considerations:
1. For the prevention of infection and/or to lower the risk of infection it may be necessary for you to be on a preventative therapy of antibiotics BEFORE surgery.
2. For the prevention of blood clots (venous thrombosis) and based on any additional underlying medical conditions, you should also discuss the possibility of being on blood thinners before the surgery.
3. Make arrangements and plans for the scheduling and/or resumption of decongestive massage therapy for the lymphedema after the surgery.
4. Be sure to have your PCP, surgeon and lymphedema therapist working together to design a treatment/therapy modality that is best for you.
5. Familiarize yourself with the carpal tunnel surgery so that you will know what to expect.
6. With consideration of surgical complications, it is important to try all methods of treatment before a surgery is planned.
7. What are the considerations of the need for a future second surgery affect your lymphedema.
8. If you are obese or morbidly obese discuss how the added strain of the surgery will affect your lymphedema.
9. Be sure to understand the specifics of what you can or can’t do, how long you will be off work, financial arrangement and the need for personal assistance you may have.
10. Discuss which type of surgery will be performed. The standard surgery or the less invasive endoscopic carpal tunnel release surgery. Learn all you can about both techniques.
Complications include possible infections, especially around an the incesion, damage to nerves or blood vessels and of special concern to those with lymphedema, the lymph nodes of the region.
General Patient Post-Operative Considerations Here are some do’s and don’ts for when you return home:
Follow closely and be absolutely compliant with the postoperative program outlined and prescribed by your physcian and therapist.
Don’t use your arm to push yourself up in bed or from a chair because this requires forceful contraction of muscles.
Do follow the program of home exercises prescribed for you. You may need to do the exercises 4 to 5 times a day for a month or more.
Don’t overdo it! If your pain was severe before the surgery, the experience of pain-free motion may lull you into thinking that you can do more than is prescribed. Early overuse of the hand/arm may result in severe limitations in motion.
Don’t lift anything heavier than a cup of coffee for the first 6 weeks after surgery. Do ask for assistance. Your physician may be able to recommend an agency or facility if you do not have home support.
Don’t participate in contact sports or do any heavy lifting for at least 6 months.
Contact your Physician if
Pain, swelling, soreness or redness in the arm. Increase in arm/wrist/hand pain Fever Discharge, pus or smelly drainage Sudden or unexplained re-swelling of joint (after initial post operative swelling has decreased) If the arm was not swollen before surgery, immediate report any post-operative edema.
Open carpal tunnel surgery for carpal tunnel syndrome
During open carpal tunnel release surgery, the transverse carpal ligament is cut, which releases pressure on the median nerve and relieves the symptoms of carpal tunnel syndrome. When you return to work depends upon whether the dominant hand (the hand you use most) was involved, your work activities, and the effort that you put into rehabilitative physical therapy.
In rare cases, the symptoms of pain and numbness may return (the most common complication), or there may be temporary loss of strength when pinching or gripping an object, due to the cutting of the transverse carpal ligament.
If the thumb muscles have been severely weakened or wasted away, hand strength and function may be limited even after surgery.
The risk and complication rates of open surgery are very low (about 5%).2 There is a small risk that the median nerve or other tissues may be damaged during surgery. There are also the risks of any type of surgery, including possible infection and risks of general anesthesia. However, most open carpal tunnel surgery is done with local anesthesia or regional block, rather than general anesthesia.
An incision is made at the base of the palm of the hand. This allows the doctor to see the transversecarpal ligament. After the ligament is cut, the skin is closed with stitches. The gap where the ligament was cut is left alone and eventually fills up with scar tissue.
Open carpal tunnel release surgery is usually done under local anesthetic as an outpatient same-day surgery.
After surgery, the hand is wrapped. The stitches are removed 10 to 14 days after surgery. You may be directed to wear a splint for several weeks. The pain and numbness may go away right after surgery or may take several months to subside. Try to avoid heavy use of your hand for up to 3 months.
3Should I have surgery for carpal tunnel syndrome?
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
- Katz JM, Simmons BP (2002). Carpal tunnel syndrome. New England Journal of Medicine, 346(23): 1807–1812.
- Jimenez DF, et al. (1998). Endoscopic treatment of carpal tunnel syndrome: A critical review. Journal of Neurosurgery, 88(5): 817–826.
- Marshall S (2002). Carpal tunnel syndrome. Clinical Evidence (7): 954–965.
Endoscopic Carpal Tunnel Release Surgery (ECTR)
Over the last few years a number of articles have appeared in the Atlanta Constitution, the Wall Street Journal and other popular publications on endoscopic carpal tunnel release. The demand for this procedure has grown as more individuals learn about carpal tunnel syndrome and the alternative treatment methods for this disorder. ECTR has become a very popular procedure because it may afford many patients a faster recovery and less pain after surgery.
Endoscopic carpal tunnel release is a very new procedure utilized over the last 2-3 years. About 10,000 ECTRs have been performed. Although this is only a small number to consider, it appears to be a very good procedure. Dr. Weil is one of the instructors in endoscopic carpal tunnel surgery which has now been taught to approximately 600 orthopaedic surgeons, hand surgeons, neurosurgeons and plastic surgeons around the United States. It is not known what percentage of surgeons are actually using this procedure but it is becoming more available as more surgeons learn how to use this device. About 80 percent of carpal tunnel surgery is still being done as an “open” procedure.
Endoscopic carpal tunnel release itself is an operation where a small incision is made in the wrist and in the palm and an endoscope is used to visualize the carpal ligament which is cut with small blades under direct visualization. The difference between ECTR and open carpal tunnel release is that with ECTR there are only two small incisions required. However, with open carpal tunnel procedures, a relatively lengthy incision which is usually between 4 and 8 cms (2″ to 5”) is utilized to release the carpal tunnel. By using an endoscopic technique for surgery it is believed that the skin and soft tissue of the palm can be preserved and therefore less post operative pain and more rapid recovery may be possible.
Since this is a new procedure, there is still a great deal that remains to be investigated. It is important to determine whether in the future ECTR will allow for the same results of open carpal tunnel release, which are quite good. It is hoped that ECTR will be as effective as open carpal tunnel surgery and that there will not be a high rate of recurrence of carpal tunnel syndrome following ECTR. The complication rate of ECTR does not appear to be an greater than open carpal tunnel surgery. The complication rate of open carpal tunnel surgery that is often cited is between 12 percent and 25 percent of patients that have some problem following carpal tunnel surgery. Early studies of ECTR show that there is no greater complication rate with this new procedure, and it may actually have less complications.
The surgery itself (ECTR) is performed under local anesthesia ( with additional medication if “Twilight” anesthesia is needed). The operation is performed on an outpatient basis. The operative takes about 30-45 minutes to complete and is done in an operating room. Most patients wear a “post-operative” splint for 4-5 days until sutures are removed. Then, they return to wearing a wrist splint or glove until post operative pain subsides. Some require use of a glove or splint at work.
Perhaps the most impressive part about endoscopic carpal tunnel release is how quickly patients appear to recover from this operation. Although many patients do complain of pain in the palm and some discomfort with the fingers after surgery, most appear to be able to resume mostof their day to day activities within a few days after surgery and often return to work 3-6 weeks after surgery. Open surgery with longer incision takes a substantially longer time for recovery. Even with ECTR, many patients are required to avoid heavy lifting and repetitive motion for 6-8 weeks after surgery. The need for therapy is lower due to less swelling and easier use of hand following surgery.