Median nerve decompression (Carpal Tunnel Release) is a surgical procedure specifically used to treat carpal tunnel syndrome. This condition is caused by compression of the median nerve within the carpal tunnel, leading to numbness, pain, and muscle weakness in the hand. The goal of the surgery is to cut the ligament to increase space for the nerve, alleviating symptoms caused by nerve compression.
This treatment is typically suitable for patients who do not respond to conservative therapies or whose symptoms significantly impact daily life. The surgery can be performed using open or endoscopic techniques, with the choice depending on the patient's condition and the surgeon’s experience.
Open median nerve decompression requires a 3-4 cm incision on the palmar side of the wrist, directly cutting the ligament at the top of the carpal tunnel. This method allows direct visualization of tissues and is suitable for cases with severe tissue swelling. Endoscopic surgery uses a camera and specialized instruments through small incisions to cut the ligament, resulting in less tissue damage and faster recovery.
The mechanism of the surgery involves reducing mechanical pressure on the median nerve, improving blood flow and nerve function. After cutting the ligament, wrist tissues naturally metabolize waste products, reducing inflammation and alleviating symptoms.
Mainly applicable in the following situations:
If symptoms have led to occupational limitations or unmanageable pain, a surgeon may recommend surgery. Other nerve compression conditions (such as cervical spine disorders) should be ruled out.
This is a surgical procedure usually performed on an outpatient basis or with short hospitalization. Local or general anesthesia can be used, with the operation lasting approximately 30-60 minutes. Postoperative dressings are applied, and a splint is used to immobilize the wrist for 24-48 hours.
There are no medication dosage issues, but strict adherence to postoperative care instructions is essential. Rehabilitation typically begins 1-2 weeks after surgery to restore wrist mobility and strength.
Main advantages include:
Compared to conservative treatments, surgery can quickly relieve mechanical compression, especially effective for severe nocturnal symptoms or muscle atrophy. Long-term follow-up shows a higher success rate for surgical intervention than non-surgical methods.
Possible risks include:
Serious complications include nerve or blood vessel injury, leading to permanent sensory abnormalities. Endoscopic surgery may result in incomplete ligament cutting due to instrument mishandling. Close monitoring of postoperative sensory changes in the hand is necessary.
Contraindications include:
Patients should inform their doctor if they are taking anticoagulants, which may need to be temporarily discontinued. Diabetic patients should control blood glucose levels below 120 mg/dL.
NSAIDs should be discontinued before and after surgery to reduce bleeding risk. If corticosteroid injections have been administered, a minimum interval of 2 weeks before surgery is recommended. Postoperative physical therapy should avoid excessive wrist stretching to prevent wound dehiscence.
The timing of nerve block treatments should be coordinated; surgeons may advise waiting 6 weeks post-surgery before nerve stimulation therapy to avoid interfering with tissue healing.
Studies show that open surgery has a success rate of up to 89% over five years, while endoscopic techniques have about an 85% success rate. One-year postoperative assessments indicate that 83% of patients regain normal work ability, with greater improvement in severe cases compared to mild cases.
Nerve conduction velocity tests show an average 30% increase six weeks after surgery, indicating gradual nerve function recovery. Randomized controlled trials confirm that surgical treatment is more effective than conservative therapy, with an odds ratio (OR) of 2.37.
Non-surgical options include:
The disadvantages of alternative therapies include inability to address ligament structural issues, with long-term symptom recurrence rates of 40-60%. Medications (such as nerve nutrients) only provide supportive care and cannot replace anatomical correction through surgery.
Before undergoing carpal tunnel surgery, doctors typically arrange nerve conduction studies or imaging to confirm the extent of the lesion. Patients should inform their doctor if they are taking anticoagulants (such as aspirin), which may need to be temporarily stopped to reduce bleeding risk. On the day of surgery, fasting for 8 hours and preparing for postoperative hand protection or bandages are recommended.
How can postoperative hand swelling be improved?Postoperative swelling is common and can be alleviated by applying ice packs to the affected area (15 minutes each time, several times daily). Keep the hand elevated above heart level and avoid early lifting of heavy objects or repetitive wrist movements. Swelling usually subsides within 2 to 4 weeks; if it worsens, immediate follow-up is necessary.
What are the key steps in postoperative rehabilitation?Within the first week after surgery, focus on passive joint movements, such as gentle finger flexion and extension. After two weeks, light resistance exercises can be introduced, including grip strength training guided by a physical therapist. Continue for 6 to 8 weeks to gradually restore wrist strength and flexibility, avoiding excessive force that may cause scar adhesion.
Is there a high risk of symptom recurrence after surgery?Research indicates that the recurrence rate after proper surgical execution is below 5%. However, patients whose occupations involve repetitive wrist movements (such as typing or assembly line work) should incorporate rest breaks and posture adjustments. Maintaining correct work habits post-surgery is key to preventing recurrence.
When should surgery be chosen over conservative treatment?If symptoms persist for more than 6 months, severely disturb sleep due to nocturnal pain, or electromyography shows severe nerve damage, surgery usually yields better outcomes than medications or splints. If thenar muscle atrophy or ongoing muscle weakness occurs, surgeons tend to recommend surgery to prevent permanent nerve injury.
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