Carpal tunnel release is surgery to treat carpal tunnel syndrome. This describes pain and numbness in the hand, caused by pressure on the median nerve in the wrist.

The median nerve and the tendons that flex (or bend) your fingers, pass through a passage in the wrist called the carpal tunnel. The thick carpal ligament just under the skin forms the roof of this tunnel. This tunnel is narrow and can compress the median nerve, causing pain and numbness in the hand. During the operation, the surgeon will cut the carpal ligament to make more space for the nerve.

Why the procedure is performed?

People with symptoms of carpal tunnel syndrome usually try nonsurgical treatments first. These may include:

• Anti-inflammatory medicines
• Therapy to learn exercises and stretches
• Wrist splints
• Cortisone injections into the carpal tunnel

If these measures fail, the carpal tunnel surgery may be required.

The surgery is performed in the following way:

• Surgery may be completed under general or local anaesthetic
• A small surgical cut is made in the palm of your hand near your wrist
• Next, the ligament that covers the carpal tunnel is cut to relieve the pressure on the median nerve
• The skin is closed with sutures (stitches) and a compressive dressing applied

Nerves serve as the “wires” of the body, which carry information to and from the brain. Motor nerves carry signals from the brain to muscles to make the body move. Sensory nerves carry signals to the brain from different parts of the body to signal pain, pressure, and temperature. Most nerves in the body are made up of both sensory and motor fibres.

Nerves are delicate and can be damaged by pressure, stretching, or cutting. Injury to a nerve can stop the transmission of signals to and from the brain, preventing muscles from working and causing loss of feeling in the area supplied by that nerve.

To fix a cut nerve, the insulation around both ends of the nerve is sewn together. As most nerves are small, this will require very fine sutures inserted with the aid of an operating microscope. Once the two ends of the nerve are attached, the nerve fibres will start to re-grow, but this occurs at the rate of 1mm a day, so recovery will be slow.

If the cut nerve is not repaired, the growing nerve fibres may grow into a ball at the end of the nerve, forming a nerve scar called a ‘neuroma’. This can be painful and cause “electric shock” feelings when touched. The best way to prevent a neuroma forming is to surgically repair the cut nerve.

The hand is commonly affected by arthritis. This causes pain and stiffness of a joint due to wearing out of the smooth cartilage on each side of the joint.

The finger joints and joint at the base of the thumb are commonly involved and can lead to marked pain and loss of function.

Splinting and anti-inflammatory medications can help the pain but not infrequently, surgery is required to treat advanced arthritis.

In the fingers, the type of surgery will depend on the joint involved but may include fusion (making a joint stiff with a plate or pins) or a joint replacement (similar to a “mini knee replacement”).

Women, especially those older than 50, are 10 to 20 times more likely than men to develop thumb arthritis. If pain persists despite non-operative measures, surgery may be recommended. Most thumb surgeries remove some or all of the arthritic bone and use various methods to stabilize the joint. On average, these procedures have a 95-96% success rate in relieving pain.

The hand can often be injured by accidents either at work or at home. Hand injuries account for 5-10% of emergency department (ED) visits nationwide.

The most common mechanisms of injury are blunt trauma (eg crush injury, contusions, abrasions), laceration, avulsion, ring avulsion, and burns. Besides skin and superficial tissues, the muscles, ligaments, and tendons of the hand are vulnerable to injury, as are the nerves and blood vessels that supply these structures.

Damage to these structures can create permanent functional and/or sensory deficits specific to the site of injury. All hand injuries require careful physical examination to rule out damage to the underlying structures and will frequently require surgery to explore the wounds and repair any injured structures.

Lacerated tendons, nerves and arteries can be repaired and with good rehabilitation, can regain excellent function.

The hand and wrist are made up of many bones that form a supporting framework. These bones act as a point of attachment for the muscles that make the wrist and fingers move. A fracture occurs when enough force is applied to a bone to break it eg Sporting injuries or motor vehicle accidents. When this happens, there is pain, swelling, and decreased use of the injured part. The terms “fracture” and “break” have the same meaning and can be used interchangeably.

The best form of treatment will be determined by a Hand Surgeon after clinical examination of the affected region and appropriate x-rays. Many hand and wrist fractures can be treated without surgery, but if they are displaced or extend into a neighbouring joint, surgery may be required. A variety of pins, wires, plates and screws are used to stabilise fractures.