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Carpal Tunnel Release

To help patients struggling with advanced symptoms of carpal tunnel syndrome, Dr. Greenwald can perform a carpal tunnel release procedure. This surgical treatment option is often the last resort for patients whose pain and loss of dexterity have become advanced, or patients who are rapidly losing muscle mass in their hands due to this affliction. Fortunately, carpal tunnel release has become quite advanced over the years and can provide significant relief. Dr. Greenwald routinely performs this surgery and can even use specialized techniques, like the MANOS Carpal Tunnel Release system, for faster healing.

If you are suffering from carpal tunnel syndrome and your doctor suggested carpal tunnel release surgery, please set up an appointment at our Mountain View or Redwood City practices, to meet with Dr. Greenwald. Just give us a call at 650-968-4747, or click the “Request Appointment” link to schedule online.

What is Carpal Tunnel Release Surgery?

The carpal tunnel is a structure within the wrist that accommodates the median nerve and the various tendons that are responsible for moving our fingers. However, due to a variety of causes, the surrounding tissues may begin to exert pressure on the median nerve. This can lead to serious problems for the patient, because this nerve is responsible for much of the physical sensation in the hand. Further, the median nerve controls impulses to some of the muscles in the hand, making it imperative for proper hand function.

When symptoms of carpal tunnel syndrome begin to manifest, it is common for patients to experience pain, a tingling/numbing sensation in the fingers, and loss of strength in the hand. When damage to the nerve becomes severe, some patients even experience a noticeable loss of muscle mass in the hand, as the muscles begin to atrophy.

For debilitating symptoms of carpal tunnel syndrome, where non-invasive treatments have failed, Dr. Greenwald may perform carpal tunnel release surgery. The main goal of this surgery is to alleviate the pressure on the median nerve by cutting the transverse carpal ligament. This creates more room for the median nerve and can quickly remove a lot of the pressure from the area.

How is Carpal Tunnel Release Performed?

Dr. Greenwald can to perform carpal tunnel release using several techniques, including the open release or the MANOS system. Either procedure is performed under IV sedation and local anesthesia.

During the open release, an incision is made in the middle of the palm, to expose the transverse carpal ligament. The ligament lies directly on top of the carpal tunnel, and forms the tunnel’s roof. To remove the pressure, the carpal ligament is cut in two. This provides immediate relief for the median nerve.

After the carpal ligament has been cut in two, Dr. Greenwald may also inspect the carpal tunnel and the median nerve, to perform additional nerve decompression if necessary.

Once the procedure is complete, the incision is sutured without suturing the carpal ligament. The ligament must remain cut in order to give more room to the median nerve within the carpal tunnel. Over time, scar tissue will develop and will attach both ends of the carpal ligament. However, the scar tissue will lengthen the ligament, thus avoiding pressure on the nerve in the long term.

MANOS Carpal Tunnel Release

In addition to open surgery, Dr. Greenwald may also suggest the MANOS system for some patients. This surgical option offers a way to cut the carpal ligament without open surgery, and uses two small puncture incisions instead.

To perform this procedure, two small puncture incisions are made; one near the middle of the palm and one at the bottom. Small cannulas are then used to guide the cutting edge of the device directly under the carpal ligament. During the entire time, however, the cutting edge is sheathed, so that it will not cut any tissues until the surgeon is ready. Ultrasound guidance is used to ensure that the median nerve is completely avoided during this surgery.

Once the cutting edge has been correctly positioned under the carpal ligament, Dr. Greenwald will remove the protective covering of the blade and gently separate the ligament. All of this will be performed under the skin, with the highly advanced and delicate surgical tools of the MANOS device.

When the ligament has been fully severed, the cutting edge of the device will be sheathed again, so that it can be safely removed through the small incision without cutting any other tissues along the way.

Carpal Tunnel Surgery Recovery

Although many of the symptoms of carpal tunnel syndrome may disappear almost immediately after surgery, the recovery period may take several weeks. To some degree, the amount of time for recovery will depend on which type of procedure was performed.

For example, open surgery will need 1-2 weeks before stitches are removed from the incision. The healing time for the entire wrist will also be longer, because more of the tissue will have sustained trauma. However, one of the benefits of open surgery is that it allows Dr. Greenwald to look under the carpal ligament to see the condition of the median nerve, and perform addition decompression, if needed.

The MANOS approach to carpal tunnel release, on the other hand, will heal much faster, because there are no incisions or sutures. The two puncture incisions here are so small (just a few millimeters in size) that they often only need to be covered with a band aid after the surgery. This allows for faster healing and makes it easier for the patient to return to their daily routine. However, this approach does not allow for the same visual inspection of the median nerve, and may not be the best option for a patient with a very thick hand anatomy.

Benefits of Carpal Tunnel Release

When a patient is experiencing advanced symptoms of carpal tunnel syndrome and non-invasive treatments don’t seem to work, carpal tunnel release can provide many short term and long term benefits.

For example, symptoms like pain and a tingling sensation are often considerably decreased right after the surgery, providing the patient with immediate relief. With physical therapy, these improvements can be further enhanced and the range of motion and strength in the hand will also be improved.

Further, in some cases, carpal tunnel release may be an essential step to preventing additional nerve damage and saving the patient’s ability to move the hand and fingers.

Side Effects of Carpal Tunnel Surgery

Carpal tunnel release carries the common infection risks associated with any surgical procedure. However, because the procedure is performed under local anesthesia, patients don’t have to worry about risks associated with general anesthesia.

After surgery, it is normal to feel pain from the incisions and soreness in the wrist. If you undergo open surgery, it will be essential to keep the hand dry until your next visit with Dr. Greenwald, when the stitches are removed.

Your Carpal Tunnel Release Surgery Consultation

Although carpal tunnel syndrome can be a frustrating condition, you don’t have to go it alone. Dr. Greenwald has helped hundreds of patients feel better with carpal tunnel release surgery, and can help you too. He is certified by the American Board of Neurosurgery, and has performed thousands of procedures throughout his career, ranging from carpal tunnel release to brain biopsies.

To schedule your consultation with Dr. Greenwald in our Mountain View or Redwood City practice, just give us a call at 650-968-4747, or click the “Request Appointment” link below!

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