Indications for surgery:
Signs and symptoms suggestive of carpal tunnel syndrome with electrophysiology evidence or MRI evidence of carpal tunnel syndrome.
Benefits of surgery:
Typically rapid relief of carpal tunnel associated hand pain, some improvement in weakness or numbness depending on the severity of pre operative deficit.
Risks of surgery:
Very low risk of major complications. Small risk of serious allergic reaction to antibiotics or surgical preparation fluids.
~5% risk of recurrent symptoms requiring repeat surgery, worsened weakness or numbness in hand, persistent hand pain requiring ongoing hand therapy or infection.
Brief description of the surgery:
The operation is performed under local anaesthetic where the patient is awake but the hand is numb so that pain is not felt.
A small incision is made just above the wrist allowing the band of tissue (transverse carpal ligament) that is compressing the nerve (median nerve) to be divided and the nerve compression ‘released’. The wound is then closed in layers.
The operation usually takes about 10-15 minutes.
The hand will be bandaged with the fingers free to move. The bandage should stay intact, clean and dry for 1 week after the surgery. After a week the bandage can come off with the dressing left in place. You should see your GP or practice nurse 10 days after the surgery when the stitches can be removed.
I encourage constant finger movement during this time but for 2 weeks after the surgery you should not use the hand to lift anything that may require a forceful grip.
In order to wash or shower you will need to place the hand in a plastic bag, with an elastic band around the arm, elevated so no water goes on the bandages. If for some reason the dressings or bandages do get wet you will need to have them changed.
The wound heals over a few months and normal hand activity can resume after about 4 weeks.
You should avoid driving until the hand can be used without pain so as to be able to react normally in a driving emergency situation.
Return to work is very dependant upon the type of work you do and if you have a job involving heavy lifting and manual labour you may need 6 weeks off work.