Open Carpal Tunnel Decompression

WHAT YOU SHOULD KNOW:

• You may need an open surgery for your carpal tunnel syndrome (CTS). Carpal tunnel syndrome is a disorder where a nerve in your wrist is compressed (pressed in). The carpal tunnel is the space in your wrist where nerves and muscles of your hand pass through. You may have weakness, burning, swelling, or a pins-and-needles feeling in your wrist and hands. You will have pain or numbness in at least two fingers, including your thumb, index, or middle finger. You may get CTS from using your hand or wrist in the same way again and again. You may also get it if you are often around machines that cause vibrations. Conditions such as tumors, extra bone growth, injury, or infections in your wrist may also cause CTS.
  
  
• Your caregiver may suggest an open carpal tunnel surgery if other treatments do not work for you. You may also need it if you have a broken wrist or diabetes (high blood sugar). During surgery, your caregiver will cut into your wrist and free any nerves that are compressed. This will decrease the pressure on the nerves in your wrist. Having carpal tunnel surgery may improve your symptoms and make it easier to use your wrist and hand. It 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. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. 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. You may form a thick, painful keloid (scar) where your caregiver made his cuts. You may have weakness, swelling, or stiffness in your hand, wrist, or fingers. You may get a trigger finger where your fingers are locked in a bent position. A tendon (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 fingers, hand, or wrist.
  
  
• You may need surgery again to fix any new problems or if your symptoms do not go away. Without surgery, the symptoms of your CTS may get worse. You may continue to have pain, weakness, tingling, or numbness in your hand, wrist, or arm. 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. The muscles in your hand controlled by the compressed nerve may become smaller. You may stop being able to feel or move your wrist. Call your caregiver if you have questions about your surgery, condition, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• 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: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
  • General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
    
    
  • Local anesthesia: This is medicine to make you more comfortable during your surgery. It is a shot of medicine put into the skin of your palm. It is used to numb the area and dull your pain. You may still feel pressure or pushing during surgery.
    
    
  • Regional anesthesia: This is medicine put into an IV tube in your arm. A pressure cuff is first put around your arm. After the cuff is tightened, the medicine is put into the IV. The cuff keeps the medicine in the arm so you will not have pain.

• Your hand will be placed on a special table, cleaned, and covered with a sheet. A cuff called a tourniquet may be put around your upper arm to decrease bleeding during your surgery.
  
  

During your surgery:

• Your caregiver may do a regular open carpal tunnel surgery or a limited open carpal tunnel surgery. During regular open carpal tunnel surgery, your caregiver will make a cut on the palm of your hand. This cut may extend to your wrist. If your caregiver does a limited open carpal tunnel surgery, then he only makes cuts on your palm. Your caregiver uses special tools to help him see and protect the nerve better.
  
  
• Your caregiver cuts the carpal ligament using scissors or a special knife to release pressure on your nerve. The carpal ligament is a band of tissue that connects joints in your wrist. Your joints are where two bones connect together. If the tissue covering the nerve is thick, your caregiver may decide to remove it. He may also remove scar tissue or anything else that may be pressing on your carpal tunnel nerve. The cuts are closed with stitches and covered with bandages. Your caregiver then takes off the tourniquet.

After your surgery: Your caregiver may put a splint on your wrist to keep it from moving. You will be taken to a room where you will stay and rest until you are fully awake. Your caregiver may ask you to move your fingers soon after your surgery. Your caregiver will tell you when it is time to go home. Do not try to get out of bed until your caregiver says it is OK.

• Movements: Your caregiver may give you exercises for your hand and wrist. These may include range of motion exercises where you move your fingers up, down, or sideways. Do not use your wrist to pull until your caregiver says it is OK.
  
  
• Physical therapy: Your caregiver may want you to go to physical therapy. A physical therapist will help you with special exercises. These exercises help make your bones and muscles stronger.
  
  
• Lifting: Do not lift anything heavy until your caregiver says it is OK.
  
  
• Raising your arm: 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. Always follow your caregiver's instructions for how long to use an ice pack.
  
  
• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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.

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