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So you're about to have carpal tunnel surgery…. What to expect

The most important thing to have before undertaking carpal tunnel surgery or any surgery is the proper expectations. Your doctor should have explained to you that carpal tunnel surgery, while successful in alleviating many or most of the symptoms of carpal tunnel syndrome, cannot guarantee a complete recovery. The goal of carpal tunnel surgery is to relieve the pressure on the median nerve in the palm and stop further nerve damage. The type of recovery you will have is dependent on the amount of damage that has occurred to the nerve up to this point. The good news is that most people obtain very satisfactory results that allow them to have normal use of their hands without continued pain and nighttime awakenings.

Depending on your overall condition, your doctor may ask for certain tests before surgery. These may include a nerve conduction study, and, depending on your medical condition, the doctor may ask for certain blood tests, an EKG or even a chest X-ray. Depending on where you’re having surgery, you may have to be NPO, which means having not eaten at some period of time before surgery.

Carpal tunnel surgery, although considered minor by some, is still surgery that requires some type of anesthetic, which ranges from local anesthesia, where a numbing agent is placed directly in the hand, to general anesthesia, where you are sleep for the surgery. Various levels of sedation can be given to keep you comfortable. A discussion with the surgeon and anesthesiologist will clarify these issues.

There are various techniques used in performing carpal tunnel surgery, including endoscopic and open. Long-term outcomes in numerous studies show that there is little difference between the two techniques. The endoscopic procedure offers smaller incisions and a quicker return to work, however, may have additional risks as compared to the standard open procedure. Your doctor will discuss these options with you.

After the surgery you will be taken to a recovery room area for a short period of time. There will be a bandage on your arm and you’ll likely feel numbness in your fingers. You may not have any pain depending on the type of anesthesia that was used. At this point you should try to keep your arm elevated in order to decrease swelling.

When you get home the anesthesia will start to wear off and you may experience some discomfort in your palm or fingers. You probably would have been given a prescription for pain medication, and if you feel uncomfortable you should take it as needed. Keeping the arm elevated will help decrease swelling and decrease pain. Ice packs can be used to help decrease swelling and can also help with the pain.

Although there will be a bandage about your wrist, you should have full use of your fingers and should be able to use your hand for basic activities such as eating, dressing and using the computer. Dressings stay on for usually no more than a week, and stitches come out between the first and second week.

Two weeks after surgery you should be able to return to most of your activities except those that require direct pressure on the palm. By six weeks there should be no restrictions on your activities. However, it is not uncommon to feel a little bit of discomfort with more aggressive activities such as push-ups even up to 4 to 6 months after surgery.

As was mentioned previously, the type of recovery you have is highly dependent on how much nerve damage was present before the surgery. Nerve recovery occurs even up to a year after surgery, and symptoms can improve even up to that point.

Carpal tunnel surgery is a highly effective procedure for treating the symptoms of carpal tunnel syndrome; however, it is a surgical procedure that has inherent risks. Before proceeding with this or any surgery, a discussion concerning the risks and benefits of the procedure should be discussed with your doctor.

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