64721 Neuroplasty and/or transposition; median nerve at carpal tunnel

Name of the Procedure:

Neuroplasty and/or Transposition; Median Nerve at Carpal Tunnel

Summary

In layman's terms, this procedure is a surgical intervention to relieve pressure on the median nerve, which runs through the carpal tunnel in the wrist. This can help alleviate symptoms like pain, numbness, and tingling in the hand and fingers.

Purpose

The procedure addresses carpal tunnel syndrome, a condition caused by the compression of the median nerve in the wrist. The primary goal is to relieve pain, restore function, and prevent further nerve damage.

Indications

• Persistent pain, numbness, or tingling in the hand and fingers, especially the thumb, index, and middle fingers.
• Weakness or clumsiness in the hand.
• Symptoms not improved by non-surgical treatments such as splinting or medication.
• Positive diagnostic tests like electromyography (EMG) confirming median nerve compression.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Adjustments to certain medications might be necessary, as advised by the healthcare provider.
• Diagnostic tests, such as EMG or nerve conduction studies, may be conducted to confirm the diagnosis and severity.

Procedure Description

1. Anesthesia: The patient receives local anesthesia to numb the wrist and hand, or in some cases, general anesthesia.
2. Incision: A small incision is made over the carpal tunnel area of the wrist.
3. Nerve Release: The surgeon carefully cuts the transverse carpal ligament to alleviate pressure on the median nerve.
4. Neuroplasty or Transposition: If necessary, the nerve is either freed from any surrounding scar tissue (neuroplasty) or repositioned to reduce pressure (transposition).
5. Closure: The incision is closed with sutures, and the wrist is bandaged.

Tools and Equipment: Surgical scalpel, retractors, magnifying glasses or microscopes, sutures.

Duration

Typically, the procedure takes about 30 to 60 minutes.

Setting

The procedure is usually performed in an outpatient surgical center or a hospital.

Personnel

• Surgeon (usually specialized in hand surgery or orthopedic surgery)
• Anesthesiologist or nurse anesthetist
• Surgical nurse

Risks and Complications

• Infection
• Bleeding
• Nerve or tendon damage
• Scarring
• Persistence or recurrence of symptoms
• Stiffness or pain in the wrist or hand

Benefits

• Relief from pain, numbness, and tingling in the hand.
• Improved hand function and strength.
• Prevention of permanent nerve damage if performed early.

Recovery

• Patients may need to keep the hand elevated and avoid heavy use for a few days.
• Sutures are typically removed in 10-14 days.
• Physical therapy may be recommended to restore strength and flexibility.
• Full recovery can take several weeks to months.

Alternatives

• Non-Surgical: Wrist splinting, anti-inflammatory medications, corticosteroid injections, and physical therapy.
• Pros and Cons: Non-surgical treatments are less invasive and can be tried initially, but they may not provide long-term relief if the condition is severe. Surgery offers a more definitive solution but carries the risks associated with surgical procedures.

Patient Experience

During the procedure, if local anesthesia is used, the patient will be awake but should not feel pain in the operative area. Post-operatively, patients may experience soreness and swelling, which can be managed with pain medications and ice. Most patients notice a gradual improvement in symptoms over a few weeks.