Ep 21 - Surgery for Carpal Tunnel: What You Need to Know with a Certified Hand Therapist

This episode focuses on carpal tunnel release surgery, providing valuable insights and advice for those suffering from carpal tunnel syndrome. We explore how early intervention can make a significant difference in recovery and discuss what to expect before, during, and after surgery.

• Overview of carpal tunnel syndrome and its symptoms 
• Importance of prompt intervention for improved outcomes 
• In-depth look at the carpal tunnel release procedure 
• Post-surgery care guidelines and recovery tips 

Thank you for subscribing to the channel, and we look forward to sharing more valuable information with you soon! 

Chapters

• 0:26 Welcome Introduction
• 15:17 Understanding Carpal Tunnel Release Surgery
• 8:20:48 Post

Transcript

Speaker 1: 0:00

Welcome back to the Hand-to-Shoulder Solution Giving Pain the Middle Finger. I'm your host, carl Petito. I'm an occupational therapist and a board-certified hand therapist. As a hand therapist, I specialize in orthopedic conditions that are affecting the fingertips through the shoulder. I want to talk today about carpal tunnel release surgery. Before we do, I want to make note that this is not treatment or treatment advice. This is information sharing to empower you to seek out the best services for your condition, so you can make an informed decision, so you can get well in minimal time.

Speaker 1: 0:35

Now, when the nerves have pressure on them, it results in numbness and tingling, aching, sometimes weakness and also even clumsiness. And, as with anything else, the longer the condition is occurring before it's treated, the harder it is to fix without surgery. Anytime we can get to something sooner rather than later. It's always better to be proactive sooner. Let's say, a person has been having numbness and tingling their thumb, index, long finger, half the ring finger, that thumb side of the hand for months. Even I meet some people have been having these symptoms for years. The lager goes on, typically after three to six months time frame. If it's over six months, especially if it gets closer to a year, that's pretty chronic and is most likely going to need surgical release.

Speaker 1: 1:32

Now, as we talked about in previous videos, the nerves come out of the spinal cord, travel down the arm through the armpit. There's a bundle of nerves, it's called the brachial plexus, p-l-e-x-u-s, and they branch out. There's different nerves there's a radial nerve, the ulnar nerve, the median nerve, musculocontaneous, et cetera, that plug into the muscles. The nerves carry the electrical signals from the brain and it causes a chemical reaction within the muscles and causes the muscles to contract. Muscles pull, they don't push. They're connected to tendons. So muscles connect to the bone by tendons and when they contract they move the skeleton. Sometimes with a lot of movements, a lot of aggravation, a lot of. Maybe somebody took a fall and they had a fracture and then that increased inflammation and the nerve was aggravated, or they had blunt force trauma. I have I see so many conditions where the patient falls on an all stretched hand and they actually strike the carpal tunnel and bruise the nerve and then that leads to sometimes chronic neurological symptoms. Chronic neurological symptoms, but in any case, where the nerves travel through certain tunnels that they pass through throughout the skeleton, those are pinch points and there's several different pinch points that can occur along down the course of the nerve.

Speaker 1: 2:57

So, regarding carpal tunnel syndrome, we're talking about the median nerve and the nerves are big. They're about as wide as a pen or pencil and thick like a noodle. And again, with carpal tunnel syndrome, it affects the thumb, index finger, long finger and the thumb side of the ring finger. We want to make sure that we're taking pressure off the nerve. In a previous episode we talked about using cold instead of heat, because cold shrinks and reduces inflammation in the carpal tunnel. Now let's talk about the need for surgery.

Speaker 1: 3:28

So before we do, let's look at the carpal bones, and there's eight carpal bones in the wrist you know the whole wrist there's 15 bones. There's a radius on the thumb side in the forearm, the ulna on the little finger side that connects to the elbow, then there's eight carpal bones. They each have a name. Then there's five bones in your hand. So in this area right here, there's 15 bones. There's 24 contact surfaces and there's 24 tendons that connect the muscles to the bones that travel through the carpal tunnel and there's 24 tendons that connect the muscles to the bones that travel through the carpal tunnel. So there's a lot going on in a very small space. So if you look at the palmar surface of the carpal bones it's concave, like looking into a cave. It's shaped like this, c-shaped this way. Over the top is a thick heavy ligament which forms the roof or the palmar surface of the carpal tunnel. So that tunnel is where the tendons travel through, along with the median nerve, which is again as wide as a pen and thick like a noodle, and that branches off to the thumb side of the hand, the thumb index index and long fingers and half the ring finger. So the nerve is getting pinched off in there. The surgery is to go underneath that thick ligament with a camera and then pass a tool under there that is a guide for a blade to slide and cut that thick heavy ligament over the top and that reduces the pressure. So if the roof of that carpal tunnel is formed by a thick heavy ligament and now we just very neatly slice that ligament, that opens it up and it frees the pressure off of the nerve and in a matter of weeks, many times, the numbness and tingling and aching fully goes away.

Speaker 1: 5:32

The longer the symptoms have been persisting with the carpal tunnel syndrome before surgery sometimes, the longer it'll take for the symptoms to go away. I've seen it go away immediately within a few days. I've seen it resolve in a few weeks, a couple of months, sometimes as long as six months. But again, the sooner you get it treated the better. There's orthopedic testing we can do in the office. We talked before about Phalen's maneuver to see if pinching it off here causes increased symptoms. Tenel's sign tapping on it to see if pinching it off here causes increased symptoms. Tenelsign tapping on it see if it causes zingers, some manual occlusion or a little bit of light pressure to see if does that light it up or aggravate the symptoms.

Speaker 1: 6:13

There's testing at the neck we can do to see is a nerve being pinched off between the vertebrae within the neck? A really good study is called the nerve conduction study where a certified practitioner actually measures the time it takes for electrical signals to pass through the nerves and they can measure where does it slow down amongst various pinch points and then that can help us determine is that where the nerve is being pinched off? We want to be really sure that before you have a carpal tunnel release surgery that's really the location of the problem. Sometimes there's a couple of different locations and if it's at the neck, for example. Therapy can help with that, and perhaps you need surgery at the wrist but also therapy at the neck. I just want you to be aware that there's even other areas within the forearm elbow area where it can be pinched off.

Speaker 1: 7:11

Nothing is really set in stone. All of this has to be checked out. You need a very thorough exam from your orthopedic surgeon, preferably a hand surgeon, to really get to the bottom of this and get the targeted treatment that you need Now after surgery. Most people don't need therapy after the surgery, especially if it's the orthoscopic, where you use a camera and just make a really tiny little hole behind that thick, heavy ligament that's called the flexor retinaculum or transverse carpal ligament, and they'll make a little, a little hole here. The surgeon will then pass a camera underneath and visualize that and make sure that that no implant structures are going to be involved in the surgery. Instead, they want to make sure that there's a clean line of view and then they're going to pass the surgical tool underneath and release or cut that thick, heavy ligament to free the pressure off of the nerve. Now sometimes a lot of fluid will build up in there and cause pressure on the nerve all over again. And then that's where I come in as a hand therapist to do specific exercises or specific modalities such as ultrasound, and also advise the patient on what they can do at home to relieve the pressure.

Speaker 1: 8:35

One thing no one should ever do is massage that area. It's a natural tendency when something is sore to want to rub it, just like when you hit your shin on the coffee table. You want to reach down and rub it, because deep pressure releases chemicals that decrease pain. But here any deep pressure is going to return the symptoms of the carpal tunnel syndrome. Because, remember, pressure is going to return the symptoms of the carpal tunnel syndrome Because, remember, the surgery is a release of pressure, so it's called a carpal tunnel release. And when you're cutting that thick, heavy ligament to release the pressure off the nerve, if we now we go in and massage that, we're putting pressure on the nerve.

Speaker 1: 9:13

So one thing I always explain to patients is sometimes it's more important what you don't do versus what you do. So in this case any massage should absolutely not be done. Also, you know, using the palm as a push point or a hammer or leaning on it or leaning on it when typing we don't want any pressure to the carpal tunnel. If you don't have carpal tunnel syndrome and you're putting a lot of pressure on your carpal tunnel, most likely eventually you're going to have irritation in the nerve. You're going to end up with carpal tunnel syndrome. So it's just never a good idea.

Speaker 1: 9:48

Also, when it's really swollen and irritated and inflamed, we'll ask people to place it under cold running water only until deeply cold 10 to 20 seconds, which very effectively reduces inflammation and reduces swelling. Sometimes, if that swelling stays in there long enough, the fluid, the swelling fluid, the lymph fluid, will actually start to get really thick and then that puts all the more pressure on that median nerve because now the fluid is thick. Then we'll use ultrasound, which is use use of high frequency sound waves to penetrate the tissues, kind of get that moving, soften it up and get that fluid out of there without putting the external pressure of massage, for example. Also, sometimes it's important to go back to the nighttime splint to keep that maximum diameter of the carpal tunnel position that properly at nighttime to relieve the pressure and then wean the person off of that. So just know that there's there's a lot of angles to this.

Speaker 1: 10:46

You really have to get it really really teased out as far as where exactly is a nerve being pinched off and again that's the nerve conduction study and then if you need the surgery, get the surgery sooner rather than later. A large majority of the cases after surgery do not need therapy, but the ones that do, if you're having persisting symptoms, they get the therapy again sooner rather than later and just stay off of that tunnel. Do not massage it. You don't even want to use the ice pack. The ice that puts weight on it. So we don't want any weight on that because, again, that's pressure on the tunnel. So no pressure on the tunnel. Get surgery sooner rather than later and if you have any questions, make sure you let me know. I appreciate you subscribing to the channel and I look forward to talking to you again soon. Thank you.