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Carpal Tunnel Surgery


Carpal tunnel syndrome can be viewed as primarily a mechanical problem - there simply isn't enough room for the median nerve. The aim of surgery is to increase the space available to the nerve.

The carpal tunnel is decompressed by surgically dividing the ‘roof’ of the tunnel. It is usually done under a local (numbing injection) or regional anaesthetic (where the whole arm is ‘put to sleep’). A general anaesthetic can be performed if required. The operation is performed through a smallish incision as shown in the diagram.

Surgery usually takes less than 10 minutes. Afterwards the hand will be bandaged with wool and crepe and strengthened by a strip of plaster of paris. This must stay in place until reviewed by your Practice Nurse or at your next clinic appointment (normally between 10 to 14 days). We have found that most patients prefer to have some support on their wrist following the surgery. Following discharge keep your hand elevated on pillows or in a sling for a couple of days to reduce excessive swelling. Remember to regularly move the fingers, which are not contained in the dressings/bandages, and to move your shoulder and elbow out of the sling to prevent other joint stiffness. Pain is not normally a major problem after this operation, nevertheless we recommend that you take some painkillers before the local anaesthetic wears off so that you have 'some on-board' when the pain may kick in. It is easier then to 'top-up'.

The hand must be kept clean and dry to prevent infection and avoid softening any plaster of paris splints under the bandaging. A plastic bag may be placed over the dressings and fastened securely for showering.

The sutures are removed between 10 to 14 days post-surgery when the wound is healed. As palmar skin is thicker it takes at least this length of time to heal. You may be asked to keep the area clean and dry for a day or two more, but further to that the hand should be washed and dried as normal.

The scar should be moisturised and massaged daily with a non-perfumed cream to keep it mobile and supple. This is essential especially if the scar is sensitive. Covering and protecting a sensitive scar will only make it worse. We recommend that you refrain from heavy lifting or manual work for 4 to 6 weeks to allow the roof of the carpal tunnel to reform and strengthen.

Key post-operative points

Exercises

In the first two weeks

Remember to keep a balance between keeping the fingers moving and not overdoing things. The operation site needs time to heal – by overdoing things in the early days it could lead to over-scarring and continuing pain.

Weeks 2 - 6

If you are using the hand and it hurts - STOP! If you do something and the hand does not hurt straight away but does later, then you overdone it, so learn from the it. If you go to do something and your instincts tell you it isn't right, then it probably isn't so don't do it. Within these restrictions we encourage you to use the hand but not abuse it. After 6 weeks, if the hand still feels weak then we suggest seeking advice from a hand therapist/physiotherapist if you are concerned.

Further reading:

  • Arthritis Research Campaign
  • American Orthopaedic Association
  • David L Nelson's Patient Education site