risk of CTS-operation

Surgical risk of carpal tunnel syndrome surgery

What risks remain with a surgical treatment of a carpal tunnel syndrome?

Even with strict asepsis of the operating room, the possibility an infection can not be excluded.

Frequent complications are surface disorders of the wound healing and surface infections.

The illustration shows a disorder of the wound healing after open splitting of the carpal roof. The disorder shown in the illustration was healing delayed but was normal apart from that and did not need a revision surgery. After around 1 year, the scar was pale and not conspicuous.

Following some important complications and problems (exemplary, not complete) in relation to the surgery of a carpal tunnel syndrome are described:

Risk of Dystrophy (CRPS):

It rarely happens, that severe movement disorders of the whole hand, in combination with severe swellings and severe decalcification of the bones of the hand. (CRPS,  Sudeck’s dystrophy, algodystrophy)

Especially endangered of getting a sudeck’s disorder are patients who have severe pain during the after treatment.

A CRPS  disorder can occur after every surgery (or injury) at the hand!

The illustration shows a CRPS with severe swelling of the back of the hand.

No surgeon can surely avoid the surgical risk as the cause of the disorder is not known!

Infection, disorder of the wound healing:

Deep infection or severe disorders of the wound healing are rare with the surgery of a fracture of the distal radius.

Superficial infections or disorders of the wound healing in the soft tissues can usually be treated with simple measures as the early removal of the skin sutures, prescribing antibiotics, etc.. Early actions with the first reddening avoid the progression of the infection into the depth of the carpal canal.

The reddening of the skin in the illustration was a result of an allergic reaction to the skin sutures. Reddening of the skin can also be the harbinger and first warning sign of a deep infection. With skin reddening, strict checkups are required.

Deep infections are rare, but very problematic. Follow-up surgeries and permanently remaining functional disorders can result.

As an affected person, how to recognize a disorder of the wound healing?

Surgery related pain after the durgery of a carpal tunnel syndrome reduces substantially after a few days. The mobility of the fingers and the thumb is getting better and the night rest will not be disturbed by pain in the surgical area.

If, after some days of improvement, the pain is coming again and the movability of the fingers and the thumb or even the whole hand is deteriorating, the wound should be inspected by an experienced hand surgeon or a trauma surgeon.

Especially if the wound is reddening and swelling, or if the new upcoming pain is pulsating the possibility of an infection needs to be considered.

If the suspicion of an infection grows, the wound needs to be opened immediately. A follow-up surgery should not be delayed in such a case.

Disorder of the movability at the wrist:

The surgeries of a carpal tunnel syndrome require only a short immobilization  of the wrist (not of the fingers and the thumbs).

Early movement of the fingers and the thumb (without burden!) reduces the risk of a possible restrictions in the wrist’s or finger’s movement.

The bandage after the surgery should be applied in a way, that movement is possible.

Nevertheless, after every surgical treatment of the hand – resulting of symptoms and the swelling – a reduced mobility of the hand can remain permanently!

Injury of the median nerve:

Injuries of the median nerve – which runs through the carpal canal – during the surgery is very rare. Here, the nerve can be severed or “only” squeezed. If the nerve is only squeezed, the numb feeling and the local nerve pain reduces after some month.

If the nerve is severed, an almost punctiform “electrifying” pressure mark in the scar occurs. A neuroma results. A loss in skin sensation occurs in the coverage area of the damaged nerve.

For the median nerve in the carpal canal, this means: no feeling on the grab side of the thumb, index finger, middle finger and one half of the ring finger!

The illustration shows a rare complete section of the median nerve in the carpal tunnel. This picture was taken during a follow-up surgery with microsurgical reconstruction of the injured median nerve.

The injury of the nerve can be the trigger for the emergence of a special pain symptoms (CRPS II).

Is the scar painful long after the surgery?

The scar after the splitting of the carpal roof is – as all scars in the hand – sensitive for a longer period compared to other parts of the body. Excessive (keloidal) scars on the hand are rare.

Most scars after a carpal tunnel surgery are almost not visible after 1-2 years.

The illustrations shows a scar in the 3rd week after the surgery. The easing hornyl layer in the scar is normal. This makes patients often think of a wound healing disorder. With this picture, no wound healing disorder is existing.

The skin’s upper layer consists of horn. This horny layer of the skin is not a living tissue and can not grow together.

Are after bleedings after ther surgery of a carpal tunnel syndrome possible?

Yes, but this surgical risk is also rare. In specific cases, injuries of arteries or of a bigger vein can occur.

Particularly vulnerable are the artery at the carpal tunnel, which runs arched at the exit of the carpal canal.

If the bleeding and swelling is severe in the first days after the surgery, then it’s mandatory to surgical re-open the wound to close the injured blood vessel. The possibly injured artery (palmar arch) can be microsurgically restored.

Endangered of having an after-bleeding after the surgical therapy of a carpal tunnel syndrome are persons who are taking drugs, which influence the blood clotting.