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. 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. 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.

Getting Ready

Before your surgery:

• Ask someone to drive you home when you are ready to leave the hospital. Do not drive yourself home.
  
  
• Tell your caregiver if you have diabetes or have had a broken wrist in the past. These conditions may require you to have the surgery done sooner.
  
  
• Your caregiver will ask you several questions about your symptoms. Your caregiver will check how well you can move your hand or if your hand has any numbness. You may need to have some tests to measure your grip and pinch strength. Ask your caregiver for more information about tests that you may need. Write down the date, time, and location of each test.
  
  
  • Electromyography (EMG): Electromyography is a test that measures the electrical activity of your muscles. Your muscles are tested at rest and while you are using them. An EMG test may also check the nerves that control your muscles.
    
    
  • Nerve testing: Your caregiver may do nerve testing on your hands and wrists. This helps him see how the nerves in your wrist and hand work with each other.
    
    
  • Ultrasound: An ultrasound is a simple test that looks inside of your body. Sound waves are used to show pictures of your organs and tissues on a TV-like screen.
    
    
  • Wrist x-ray: Your caregiver may want to take an x-ray to see the bone structure of your wrist and hand. This will help your caregiver plan your surgery.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• 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.
  
  
• 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.

Treatment

What will happen:

• 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. A cuff called a tourniquet may be put around your upper arm to decrease bleeding 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 limited open carpal tunnel surgery, then he will only make cuts on your palm.
  
  
• The carpal ligament will be cut to release the pressure on the nerve. The carpal ligament is a band of tissue that connects joints in your wrist. Your joints are where two bones connect together. Your caregiver may also remove anything else that may be pressing on the nerve. The cut will be closed with stitches and covered with bandages. Your caregiver will then take 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.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your surgery.
  
  
• You get sick (a cold or the flu).
  
  
• You have a fever.
  
  
• The pain in your hand becomes worse.
  
  
• You have an infection or swelling in your hand or wrist.
  
  
• You have symptoms of carpal tunnel syndrome in your other hand.
  
  
• You feel a lump on your wrist.

Seek Care Immediately if

• You cannot feel or move your wrist or hand.
  
  
• Your symptoms suddenly get worse.

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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.

Learn more about Open Carpal Tunnel Decompression (Precare)