تعريف
Carpel tunnel release is a surgery where the ligament covering the carpel tunnel is cut open.
أسباب هذا الإجراء
The median nerve runs from the forearm into the hand. Carpal tunnel syndromeoccurs when this nerve is squeezed at the wrist as it runs through the carpel tunnel. This results in pain, weakness, tingling, or numbness in your hand and wrist. Pain may also radiate up your arm.
Carpal tunnel release is a surgery to relieve pressure on the median nerve. The pressure is reduced by opening the ligament of the carpal tunnel. The ligament is called the transverse carpal ligament.
Surgery to treat متلازمة النفق الرسغي is usually recommended in the following instances:
- Other therapies have failed, including icing, splints or braces, anti-inflammatory medicines, steroid injections, physical therapy, or ultrasound.
- There is shrinkage (atrophy) and weakness of the muscles controlling the thumb.
- Studies of nerve functioning show the median nerve is not working properly.
المضاعفات المحتملة
Complications are rare, but no procedure is completely free of risk. If you are planning to have carpal tunnel release, your سيقوم الطبيب بمراجعة القائمة من المضاعفات المحتملة، والتي قد تشمل:
- العدوى
- نزيف
- تورم
- تلف العصب
- Stiffness of the fingers
- Continued numbness, tingling, weakness, or pain
تشمل العوامل التي قد تزيد من خطر حدوث مضاعفات ما يلي:
- Smoking or alcohol abuse
- مرض السكري
- Taking steroid medicine for other conditions
ما يمكن توقعه
قبل الإجراء
قد يقوم طبيبك بما يلي:
- Physical exam (concentrating on strength and sensation in the hands)
- تحاليل الدم
- Nerve conduction studies —measuring the nerves’ ability to send impulses to the muscles of the thumb
- Electromyogram (EMG) —a recording of the electrical activity in muscles
- فحص التصوير بالرنين المغناطيسي - اختبار يستخدم الموجات المغناطيسية لعمل صور لهياكل داخل الجسم
المؤدية إلى الإجراء الخاص بك:
- التحدث مع طبيبك عن الأدوية الخاصة بك. قد يطلب منك التوقف عن تناول بعض الأدوية تصل إلى أسبوع واحد قبل العملية مثل:
- الأسبرين أو غيره من العقاقير المضادة للالتهابات
- سيولة الدم, مثل كلوبيدوجريل (بلافيكس) أو الوارفارين (الكومادين)
- للترتيب من الإجراء.
- رتبي للحصول على المساعدة في المنزل بعد العملية.
- في الليلة السابقة ، تناول وجبة خفيفة. لا تأكل أو تشرب أي شيء بعد منتصف الليل.
- You may be asked to shower the morning of your procedure.
التخدير
General anesthesia or local anesthesia with sedation is used. If you have general anesthesia, you will be asleep during the procedure. With local anesthesia, the area being operated on will be numbed, and you may be given a sedation medicine to help you relax.
Your doctor will discuss with you which may be best.
وصف الإجراء
A classic open incision or an endoscopic technique may be used:
Open Carpal Tunnel Release
A short incision will be made in the lower palm and wrist area. The carpal ligament will be opened. This will free the median nerve. The incision will then be closed with stitches. A bulky bandage will be applied to the wound.
Endoscopic Carpal Tunnel Release
Two tiny cuts in the skin will be made on the palm side of the wrist. A small tool with a camera will be passed through an incision. This camera will allow the doctor to see inside of the carpal tunnel. Other surgical tools will be passed through the other incision. The doctor will use these tools to release the carpal ligament. After the camera and instruments are removed, a few stitches will be needed to close the incisions. A bulky bandage will then be placed over the wounds.
In some cases, the doctor may need to change to the open procedure.
كم من الوقت سيستغرق ؟
About 15-60 minutes
كم هو مؤلم ؟
Anesthesia will prevent pain during the procedure. Once the anesthesia wears off, you will have some pain in the area. Talk to your doctor about medicine to help manage the pain.
رعاية ما بعد العملية
في مركز الرعاية
You will be monitored in a recovery area until you are ready to go home. Your hand and wrist will be wrapped in a bulky bandage. The wrist will be elevated to control swelling. Ice packs may be applied periodically.
في البيت
عند العودة إلى المنزل ، قم بما يلي للمساعدة في ضمان التعافي السلس:
- Keep your hand elevated as much as possible for several days. This will help to decrease swelling and pain.
- Apply an ice pack to your wrist and hand for 20 minutes at a time, every 3-4 hours, for the first few days after your procedure.
- If your bandage becomes soiled, your doctor may advise you to change it or may ask you to see him or her.
- اسأل طبيبك حول, عندما هي آمنة للاستحمام, السباحة, أو نقع في الماء.
- Do not lift heavy things or strain the hand and arm until you are advised that you may do so by your doctor.
- Return to your doctor in 7-10 days to have the stitches removed.
- Follow the exercise program recommended by your doctor once you have begun to heal. You may be asked to go to physical therapy.
- Arrange to have help around the house, especially if you have had both hands operated on.
- Many cases of متلازمة النفق الرسغي are believed to occur due to repetitive actions (often related to work). Check with your doctor about how to prevent a recurrence.
- تأكد من اتباع تعليمات طبيبك.
You may have to wear a brace or splint for several weeks after surgery. Complete recovery may take four weeks or longer. The pain and numbness or tingling in your hand and fingers usually improves rather quickly. Your grasp strength will slowly begin to improve.
استدعاء الطبيب
بعد وصوله الى المنزل ، اتصل بطبيبك إذا كان أي من الحالات التالية:
- علامات الإصابة, بما في ذلك حمى وقشعريرة
- احمرار أو تورم أو ألم متزايد أو نزيف شديد أو أي إفرازات من موقع الشق
- الغثيان و / أو القيء الذي لا يمكنك السيطرة عليه بالأدوية التي أعطيت لك بعد الجراحة ، أو التي تستمر لأكثر من يومين بعد الخروج من المستشفى
- ألم لا يمكنك السيطرة عليه بالأدوية التي أعطيت لك
- Increased tingling or weakness in your hand
- Fingers become extremely swollen, cool, or discolored
- سعال أو ضيق في التنفس أو ألم في الصدر
في حالة الطوارئ ، اتصل على المساعدة الطبية على الفور.