Operation

The carpal tunnel syndrome operation does not necessarily have to take place in a hospital, but can also be performed on an outpatient basis. One should decide on it however in individual cases. If there are no risks in the form of further diseases or additional complications in the area of the carpal tunnel and the home care of the patient is ensured, an outpatient carpal tunnel syndrome operation can be performed without hesitation.

The operation itself is no different from the one in hospital. There is also the possibility of local anesthesia, in which only the affected forearm and the corresponding hand region are anesthetized.Since the anesthesia can still be maintained after the carpal tunnel syndrome operation, it is advisable to have relatives or a cab drive you home. Also in the interest of other road users, you should not drive a car on that day.

In addition to the possibility of outpatient surgery, which is usually performed as described above, inpatient surgery can also be performed. Inpatient surgery is indicated for various risks. The “Deutsche Gesellschaft für Handchirurgie” (German Society for Hand Surgery) recommends in-patient surgery if it is generally considered that a plannable operation on the hand should always be performed on one side only.

Even in cases in which the other side is also affected, sufficient time should always be allowed for the initial intervention. Sufficient time interval implies that the full weight-bearing capacity of the hand operated on first should be fully restored.

The patient cannot be adequately cared for at home.
Special complications are to be expected.
A complete synovialectomy (removal of the tendon sheaths) is performed.
It is a recurrence operation.

Surgical procedures

Open surgery of carpal tunnel syndrome via a “larger” (approx. 3-5 cm) incision is the more established procedure. Open surgery is always preferable if the operation is performed in bloodless humerus.

This means that the blood flow in the arm is interrupted for the duration of the operation so that vision is not impaired during the operation. After all, not only the clearly visible median nerve must be spared, but also its small nerve branches that leave it. For the same reason, many surgeons use magnifying glasses.

The operation begins with a 3-5 cm longitudinal incision between the ball of the little finger and the ball of the thumb near the wrist. The further preparation is done on the basis of certain orientation points. The carpal ligament is quickly reached and carefully split in layers.

After complete severance, the edges of the ligament gape wide apart. The median nerve is then examined. Depending on the extent and duration of the compression damage, it is more or less severely narrowed and discolored.

Manipulation of the median nerve should be avoided if possible. Only constricting adhesions should be removed. In the case of an inflammatory thickening of the tendon sheaths of the forearm flexors, as occurs more frequently in a rheumatic underlying disease, removal of the inflammatory tissue is indicated to reduce the content of the carpal tunnel.

Subsequently, the floor of the carpal tunnel is examined for space-consuming processes (bone spikes, ganglia, tumors) and if present, these are removed. The operation ends with the skin suture. A forearm plaster splint can also be applied to support the hand.

Anatomically rare variants of the carpal tunnel are present.
Tendinitis of the flexor tendons is present.
Other space receivables exist.
This is a second intervention.
The wrist mobility is restricted.

Arthroscopic surgery is also known as keyhole surgery. The aim of arthroscopic surgery is to achieve better wound healing and less scarring through a smaller tissue injury. The orthopedist and the surgeon use the arthroscope to assess and treat joint diseases; similarly, the internist uses an endoscope to assess the stomach and intestines (gastroscopy, colonoscopy).

An arthroscope can thus be called a special endoscope. It consists of a tube (trocar sleeve), an optical system of rod lenses, a light source and usually a flushing and suction device. In addition, the arthroscope has working channels through which surgical instruments can be inserted for surgical procedures.

Today, the optics of the arthroscope are connected to a monitor via a camera to facilitate work. With this arthroscope, the physician can directly view the structures to be examined, similar to a camera. Two arthroscopic procedures are available.

In the Agee technique, surgery is performed through a small incision from the wrist flexor crease, while the Chow technique requires two small skin incisions. Free extensibility of the hand in the wrist is a prerequisite for both procedures. Just as in the open surgical method, the carpal ligament is split under visual control.The advantage of the arthroscopic technique is the smaller skin incision and thus also the smaller scar. However, many surgeons see some decisive disadvantages in the arthroscopic procedure, which are listed below:

Arthroscopy carries an increased risk of vascular and nerve injuries.
It is not possible to evaluate the carpal tunnel floor.
It is not possible to evaluate the contents of the tunnel.
It is more difficult to check whether the retinaculum is completely split.