Endoscopic Carpal Tunnel Decompression

WHAT YOU SHOULD KNOW:

• You may need endoscopic surgery for your carpal tunnel syndrome (CTS). Carpal tunnel syndrome is a disorder where a nerve in your wrist is compressed (pressed in). When you have CTS, may have a pins-and-needles feeling in your wrist and hands. You will have pain or numbness in at least 2 fingers, including your thumb, index, or middle finger. At night, you may wake up with pain or weakness in your hand or wrist. You may have CTS because you use your wrist in the same way again and again. Diseases like arthritis or diabetes may also cause CTS. Your caregiver may suggest endoscopic carpal tunnel surgery (ECTS) if other treatments do not work for you.
  
  
• ECTS is a closed surgery, which means that your caregiver will do the surgery from inside your wrist. That way, your caregiver does not have to cut down into your wrist. Instead, he uses an endoscope that has a camera to help him see inside your wrist. The carpal ligament is a band of tissue that connects joints in your wrist. Cutting this ligament decreases the pressure on the nerves in your wrist. Having an ECTS may improve your symptoms and help you to function better. ECTS may improve the strength of your grip and your pinch. It may also decrease your time off from work due to pain and weakness caused by CTS.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Your hand may get an infection or get a bruise under the skin. The pain in your hand may not go away or may come back. Your scars may be painful and your finger may become stuck in a bent position. During the surgery, your caregiver may decide that he needs to make a larger cut. You may bleed more than expected. A tendon (strong tissue that connects muscles to bones), nerve, or blood vessel may be cut. If a nerve is cut, you may have long-term numbness or weakness in your index finger or thumb. You may need another surgery to correct some of these problems.
  
  
• If you do not have surgery, the pain in your hand may get worse. Your hand may feel more weakness or numbness. You may have a hard time using your hand when this happens. You may not be able to work or do things you normally do. You may stop being able to feel things on your wrist. You also may no longer be able to move your wrist. Call your caregiver if you have questions about your medicine, condition, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Pre-op care: Your hand will be placed on a special table, cleaned, and covered with a sheet. Your caregiver will give you anesthesia medicine to help decrease the pain during your surgery. You may be given local anesthesia to numb your wrist and hand. You may also get regional anesthesia that numbs your arm or general anesthesia to keep you completely asleep.
  
  
  • Local or monitored anesthesia: Anesthesia is medicine that keeps you from feeling pain during surgery or a procedure. Local anesthesia is a shot of numbing medicine put into the skin where you will have surgery. You will be fully awake during the surgery or procedure. You may feel pressure or pushing, but you will not feel pain. Monitored anesthesia means you will also be given medicine through an IV. This medicine keeps you comfortable, relaxed, and drowsy during the surgery or procedure.
    
    
  • Intravenous (IV) regional anesthesia: This is medicine put into an IV in the injured arm or leg. A pressure cuff is first put on your arm or leg. After the cuff is tightened, the medicine is put into the IV. The cuff keeps the medicine in the arm or leg so you will not have pain.
    
    
  • General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

During your surgery:

• A cuff called a tourniquet may be put around your upper arm to decrease bleeding during your surgery. Your caregiver makes one cut on your wrist by your palm if you are having one portal ECTS. If you are having two portal ECTS, your caregiver also makes a cut higher on your palm. Your caregiver inserts the endoscope with the camera to help guide him during surgery. Special tools may be put in your wrist to help protect your nerves.
  
  
• Your caregiver uses small scissors or a special knife to cut the carpal ligament that is pressing on nerves in your wrist. He cuts from inside the wrist and will not have to make any further cuts into your arm. This helps decrease the pressure on the nerve that may be causing your symptoms. The cuts are closed with stitches and covered with bandages. Your caregiver then takes off the tourniquet.

After your surgery:

You will stay in a room until you wake up or gain feeling in your arm. Do not try to get out of bed until your caregiver says it is OK. Your caregiver will tell you when it is time to go home. You will be asked to move your fingers soon after your surgery. A splint will be put on your wrist to keep the wrist from twisting or bending.

• Activity: Your caregiver may want you to go to physical therapy. A physical therapist will help you with special exercises. These exercises help make your wrist and hand stronger. Do not use your wrist to pull until your caregiver says it is OK. Also, do not lift anything heavy.
  
  
• Raising your arm (elevation): Your caregiver may tell you to raise your arm at different times during the day. Raising your arm may help decrease your pain.
  
  
• Ice: Your caregiver may want you to put ice on your wrist and hand. This may help decrease your pain and swelling. Do not sleep with the ice pack on your wrist.
  
  
• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Pain medicine: You may need medicine to take away or decrease pain.
    
    
    • Learn how to take your medicine. Ask what medicine and how much you should take. Be sure you know how, when, and how often to take it.
      
      
    • Do not wait until the pain is severe before you take your medicine. Tell caregivers if your pain does not decrease.
      
      
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling someone when you get out of bed or if you need help.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.