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Carpal Tunnel Release Surgery
Carpal tunnel release surgery is a surgical procedure that treats problems caused by carpel tunnel syndrome. Physiotherapy after carpal tunnel release surgery is essential to return full function in the affected wrist, hand and arm.
Carpal tunnel syndrome is characterised by pain and weakness in the forearm, wrist and hand caused by pressure on the nerves in the wrist. The carpal tunnel is a channel in the palm and wrist. The bones of the wrist are arranged in a semi-circle and a rough ligament called the transverse carpal (TC) ligament forms a layer over them. This creates a passageway between the bones of the wrist and the TC ligament. Running through the tunnel are essential nerves and tendons that produce movement in the fingers and wrist. The main nerve that runs through the carpal tunnel nerve is the median nerve. Any swelling of the tissue in around the carpal tunnel can cause the median nerve to become compressed resulting in carpal tunnel syndrome.
Above: Functional wrist exercises supervised by MSK physiotherapistCarpal tunnel syndrome causes numbness, tingling and burning in the hand and fingers. Symptoms that are also experienced are pain, muscle weakness and reduced function in the wrist, hand and forearm. Structures most likely to be affected are your thumb, index finger, middle finger and the side of your ring finger nearest your thumb. Additionally, carpal tunnel syndrome is worse at night or first thing in the morning.
In order to reduce the symptoms and to treat carpal tunnel syndrome, carpal tunnel release surgery is required. Carpal tunnel release surgery can be done with the patient sitting in a chair with the affected arm resting on the operating table or with the patient lying down with the affected arm out to the side. Prior to the surgery, the patient will be given a local anaesthetic. Carpal tunnel release surgery can be done by one of two techniques:
- Endoscopic (keyhole) release surgery
- Open release surgery
During endoscopic release surgery one or two small incisions about 2cm long are made just above the wrist or in the palm of the hand. A narrow, tube like endoscope (camera) is inserted into the cut to allow the surgeon to observe inside the wrist. A special instrument is then attached to the end of the endoscope and the transverse carpal ligament is cut in order to decompress the median nerve. The endoscope is then removed and the wound is closed using stitches.
Open Release Surgery
During open release surgery a single cut about 5 cm long is made at the front of the wrist or at the bottom of the palm. Beneath the incision the skin and tissues are divided allowing sufficient access to the transverse carpal ligament. The TC ligament is then cut and the median nerve decompressed. Once the nerve is released, the wound is then closed up using stitches.
Carpal tunnel release surgery is essential to treat problems caused by compression of the median nerve as well as providing the return of full function in the affected hand, wrist and arm. Physiotherapy after carpal release surgery is highly important to maximize the success of the surgery, enhance the return of function and to prevent the likelihood of any future problems occurring that are related to carpal tunnel syndrome.
Symptoms after carpal tunnel release surgery
After you have undergone carpal tunnel release surgery you will experience some pain, swelling and reduced range of movement in and around your wrist. You will be given painkillers and you are advised to keep your wrist elevated as much as possible using pillows.Immediately after the surgery you may feel drowsy and your wrist and hand may be numb as a result of the anaesthetic used. As a result of the surgery, you will feel some loss of strength and function in your hand, wrist and forearm in the initial period of your recovery. You will be provided with a wrist splint and an arm sling for essential support and protection. Dissolvable stitches will disappear between seven and ten days. Non dissolvable stitches are removed after ten to fourteen days. Physiotherapy will begin immediately after your carpal tunnel release surgery to help regain strength, range of movement and function in you lower arm, wrist and hand as soon as possible after your surgery. You will be unable to drive until you have a full and painless range of movement in your wrist and hand.
Physiotherapy after carpal tunnel release surgery
Physiotherapy is required as soon as possible once you have undergone carpal tunnel release surgery to reduce pain and stiffness as well as improve mobility, range of movement and strength in your affected lower arm, wrist and hand. A comprehensive physiotherapy programme with Physio.co.uk will help you achieve the return of full or near to full function in your wrist whilst also helping to prevent any permanent damage and future problems occurring. Physio.co.uk offers a programme that includes goals that are personal to you. Goals include:
- To restore a pain free wrist
- To restore full range of motion (ROM)
- To restore full muscle strength
- To restore full muscle length and flexibility
- To improve cardiovascular fitness and muscle endurance
- To re-establish function and independence
Week 1 - 4
In the initial week after your carpal tunnel release surgery, you will be wearing a wrist splint and a sling. Your physiotherapy at this stage will mainly consist of pain modalities to control for any pain you will be experiencing. Rest, ice, compression and elevation (RICE) is encouraged in the immediate stages of recovery. You will be given advice on ways you can reduce swelling such as elevating you lower arm using pillows etc. Furthermore, goals of your rehabilitation with Physio.co.uk at this stage will be to ensure that there is full active range of movement in both your shoulder and elbow. Physiotherapy will also focus on improving active and passive (assisted) range of movement in your wrist and finger joints.
- Pain killers (to control pain)
- Elevation (to control swelling)
- Passive (assisted) range of movement exercises for affected arm (wrist, hand, elbow and shoulder)
- Active (on your own)range of movement exercises for affected arm (wrist, hand, elbow and shoulder)
- Strengthening and range of movement exercises for unaffected arm
Week 5 – 8
During the second month of your rehabilitation with Physio.co.uk, goals will concentrate on the continuation and progression of activities from previous weeks. The goals of your rehabilitation will include controlling pain and swelling, improving range of movement and flexibility along with increasing muscle strength and control in the muscles of your wrist, hand and forearm. Your physiotherapy will include:
- Continuation of modalities for pain and swelling
- Passive (assisted) and active (independent) range of movement exercises
- Gentle strengthening exercises (isometric – hold) for muscles of affected arm (pronator teres, supinator, wrist flexor muscles, wrist extensor muscles, hand and finger muscles)
- Passive (assisted) stretching exercises for muscles of affected arm Range of movement, strengthening and stretching exercises for unaffected arm
- Mobilisation of wrist joints
- Hand grip strengthening exercises
- Wrist, hand and elbow exercises
- Hydrotherapy
Week 9 – 14
After three months of rehabilitation with Physio.co.uk, your physiotherapy programme will continue to focus on the progression from previous weeks. The main goals of your physiotherapy programme with Physio.co.uk will aim to minimise pain and improve range of movement in your affected lower arm. It is very important during this period to focus on progressive strengthening exercises for the muscles in your hand, wrist, forearm and elbow. At this stage, your physiotherapy will also begin to include activities that will improve your cardiovascular fitness and muscle endurance. Your physiotherapy will include:
- Pain control
- Range of movement exercises for joints of hand, wrist and forearm
- Flexibility exercises
- Passive stretching (assisted) programme-with combined movement
- Strengthening exercises for muscles in affected and unaffected arm (pronator teres, supinator, wrist flexor muscles, wrist extensor muscles, hand and finger muscles)
- Mobilisation of wrist joints
- Hand grip strengthening exercises
- Hydrotherapy
- Arm cycle
Week 14 onwards
After three to four months of successful physiotherapy with Physio.co.uk your rehabilitation will focus on maximising strength and function in your wrist and hand. By this time, you should not be experiencing any pain or swelling around the area of the incision. You will have seen marked improvements in the range of movement and function in your lower arm. Goals of your physiotherapy will be to continue to include activities that maximise range of movement, strength, muscle endurance, cardiovascular fitness and function in your affected and non affected arms. Physio.co.uk will also include functionally activities that are specific to your everyday living, hobbies or sport.
The success of your recovery after carpal tunnel release will highly depend on your commitment to your physiotherapy programme as well as the condition of your wrist prior to the surgery. Recovery may take three to four months.
Summary
Carpal tunnel release surgery is a surgical procedure that treats problems caused by carpal tunnel syndrome. Carpal tunnel syndrome occurs in the wrist when the median nerve becomes compressed by surrounding structures such as the transverse carpal ligaments. Carpal tunnel release surgery aims to cut the transverse carpal ligaments to make more space for the nerves and tendons that run underneath it in the carpal tunnel. Carpal tunnel release surgery treats symptoms that arise from carpal tunnel syndrome such as pain, numbness, tingling and burning in the hand and fingers as well as preventing permanent damage to the nerve. Physiotherapy after carpal tunnel syndrome is crucial to maximise the success of the surgery, reduce pain and stiffness and improve mobility and function in the forearm, wrist and hand. A personal physiotherapy programme with Physio.co.uk will help you achieve the return of full or near to full function in your wrist and get you back to what it is you love doing the most as soon as possible. Call Physio.co.uk now on 0330 088 7800 for more information or to book an appointment please contact us.
