Dr. Jeffrey Wint is a hand surgeon practicing in Springfield, MA. Dr. Wint specializes in caring for hand, wrist and forearm problems without the option of surgery unless necessary. Many hand surgeons are also experts in diagnosing and caring for shoulder and elbow problems and tend to suggest non-surgical treatments such... more
Carpal Tunnel Release Local Only
Open Carpal Tunnel Surgery can be done with local medication only.
Among the many advances in local anesthesia of the hand, one of the most significant changes in the last few years is the following: the acceptance of safety of locally infiltrated epinephrine with lidocaine for hemostasis, which has removed the need for sedation, brachial plexus blocks, and general anesthesia for most common hand surgery operations and minor hand trauma.
Like dental procedures, wide awake hand surgery can be performed with no intravenous sedation.The surgeon injects into the hand a mixture of only 2 medications; lidocaine for anesthesia and epinephrine for hemostasis.
No need to fast or change medication schedules.
Patients with sore elbows, shoulders or backs can position themselves comfortably.
After the surgery, less time is needed as there is no need to recover from sedation or unnecessary opiates.
Studies have shown that having carpal tunnel release without sedation or under local does not increase the need for postoperative opiods, in fact, many patients who have open carpal tunnel surgery under local do not need post operative opiods or use very little.
Carpal Tunnel Surgery
Answers to common questions
While the goal of surgery is to relieve the pressure on the nerve, not everyone will respond the same to surgery.
Some patients will have immediate return of sensation...
...while some will take longer. Some will notice an improvement right away but still feel tingling and will describe this as "numb". The return of sensation is dependent on many factors including age, general health, duration of symptoms, circulation and the actual mechanical severity of compression.
While decompressing the nerve stops the carpal tunnel syndrome from getting worse, full recovery of sensation may not be possible.
Often, this is seen in patients who have muscle wasting noted prior to surgery and in those with longstanding, complete numbness and elevated two-point discrimination. Of course there are many in this category that improve despite having very severe cases.
Having a severe case where you are not sure if you'd have a full recovery is not a reason to put off surgery, as progression is unlikely if nothing is done.
What is actually "released"...
...is the hard ligament in your palm that covers the median nerve. Together with the bones in your wrist this ligament forms a ring or tunnel that surrounds the median nerve and the tendons to your fingers and thumb. When this "release" is done it is much like making a ring bigger and there is less pressure on the median nerve. The body heals the cut in this enlarged ring. But it takes time until your palm feels comfortable. With the pressure reduced on the nerve, healing can occur. How the nerve heals is different in everyone.
...you may be able to use your hand right away, especially your fingers to do light things. You must keep your dressing dry until it is changed or removed in the office. For showers or baths keep your dressing covered with a plastic bag.
The time for healing...
...is variable as no two people are alike and no one heals exactly the same. However most feel comfortable doing light activities that require palm pressure in 2-3 weeks and very heavy activities 4-5 weeks. Those with lighter sedentary jobs can often go back sooner. Those with very heavy jobs may take longer. Other conditions such as arthritis, tendonitis and fibromyalgia may delay comfort after surgery. Sometimes you do not complain of or notice other problems until after your carpal tunnel is better.
The type of anesthesia used...
...is typically known as local only often referred to as WALANT, which means wide awake local and no tourniquet or "local with monitored anesthesia care" (or IV sedation).
If local only or WALANT is used there is an injection to the hand and the surgery is done and one is wide awake without the need to fast or change medications.
If IV sedation is used, this means that you get an intravenous dose of medicine to relax or lightly sedate you. An anesthesiologist, a physician who is in charge of this part of your operation, gives the sedation. Then the surgeon injects your palm to "numb it up". The sedation usually makes you forget that you had the palm injection. When the surgery starts you do not feel the incision, but you know that something is going on because the back of your hand and your fingers still are awake (Some fall gently asleep at this point but many stay awake and are indifferent to what is happening.)
Most carpal tunnel is done as day surgery and most patients can have it done at the surgicenter without the need to go to the hospital.
It is usually a 20-25 minute procedure with total time in the surgery center about 2 hours. You need to have a ride from surgery and cannot drive for 24 hours. After 24 hours you may drive as long as you feel safe and are not taking pain medicine, which can impair your judgment. The requirement of insurance carriers and some people because of other medical problems, or sometimes because of scheduling, need to go to the hospital for surgery. Then you would expect to spend about 4-5 hours at the hospital. The surgicenter has you arrive 80 minutes prior to your scheduled surgery time. While at the hospital you need to get there 2 hours ahead of the surgical time.
While everyone who has carpal tunnel surgery gets a prescription for pain medicine, most state that they did not need it or used it minimally. Many get by with Tylenol, Advil, Aleve or a similar over the counter medication.
The wait to schedule surgery is typically two or three weeks...
...but in certain instances surgery can be scheduled quicker than that. Ask the staff to help you.
If you have a date in mind for surgery you should not wait until right before that time to discuss scheduling with the office, just to make sure the date is available. In general, we cannot give an exact time of the day and the time may change even a day before.
For any scheduling questions please speak to the office staff.
They will be happy to go over dates with you. If you have specific questions about carpal tunnel surgery, please contact us as well. Please remember that not all the answers here will apply equally to everyone.
Know the risks and benefits of surgery and understand the surgery
Read the AAOS Informed Patient Tutorial on Carpal Tunnel from which the below is based upon:
Risks and Complications
The complication rate following carpal tunnel release is very low. Most complications, if they occur, are minor and can be treated. However, there are rare instances where more severe complications occur.
It is important that you know and understand the risks before you make the decision to have surgery. Possible surgical complications include:
Infection is possible with any surgery. Rates of infection in carpal tunnel release surgery are considered to be extremely low. If an infection does occur, it is typically treated with oral antibiotics. Occasionally, surgery may be needed to clean out the infected area.
Some surgeons give antibiotics before and/or after surgery. Studies have shown that rates of infection after carpal tunnel surgery are the same, whether antibiotics are given or not.
In some cases, carpal tunnel syndrome symptoms continue even after surgery. Typical reasons for this include:
Persistent symptoms may require further investigation for other causes. They may require an additional surgery, which is called a revision surgery.
A return of symptoms after a period of relief is possible after carpal tunnel release.
Recurrent symptoms can be caused by scar formation around the median nerve. The nerve may also scar down to surrounding structures within the carpal tunnel. Portions of the transverse carpal tunnel ligament may re-form and cause pressure on the nerve. The synovial tissue which surrounds the tendons may thicken over time causing further squeezing of the nerve.
Return of symptoms, if significant, may be a reason to undergo a revision of the original carpal tunnel surgery. Depending on the cause, the outcome of revision surgery may not be as good as the original surgery.
Your surgeon will discuss with you what to expect if further surgery is required.
Major Nerve Injury
Irreversible damage to the median nerve, branches of the median nerve, or nearby nerves are among the most serious complications of carpal tunnel surgery. Fortunately, the chance of this type of complication is less than 0.5%.
If a nerve injury does occur, there can be pain and permanent loss of feeling and function. Further surgeries may be necessary to try and improve these symptoms.