Carpal tunnel decompression

Summary

This operation is performed for a condition called carpal tunnel syndrome.  The aim of the operation is divide the ligament that crosses the base of the hand. This releases the pressure on the median nerve which runs underneath.

Factors to Consider

Symptoms from carpal tunnel syndrome vary from patient to patient. There are non-surgical treatments which may be effective especially in the early stages. Surgery is the most likely treatment to help in severe symptoms, but is more successful before symptoms get to this point.

Pins and needles are the most likely symptoms to improve rapidly, while constant numbness may well take longer to improve. Some patients have pain in the forearm which can be associated with carpal tunnel syndrome and may also improve following surgery.

Description of Surgery

The operation is usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital. You will need to remove any rings and jewelery from the hand and ideally false nails / nail varnish.

The operation is performed through a small incision at the base of the hand.  The surgeon will then identify the ligament and divide it. The wound is then stitched closed.  The operation itself takes about 10 minutes. A tourniquet is used on the upper arm for this time.

Anaesthetic

The operation is usually performed under a local anaesthetic and so you will be able to eat and drink as normal.  

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The risk of infection is very small and is thought to be less than 1%.  Most infections will settle simply with antibiotics.

Damage to the nerve is very rare. 

The scar and base of the hand can be uncomfortable at first if pressed upon, but usually settles soon.

The risk that your symptoms do not fully resolve is mostly related to their severity.

Some stiffness and swelling is common and usually resolves rapidly with elevation and movement of the fingers. Complex regional pain syndrome is a rare complication that may cause more prolonged pain, stiffness or swelling.

After Surgery

Pain

The local anaesthetic lasts for several hours after the operation and simple painkillers are usually all that is needed after this. It is important that you take regular pain relief at first so that you can keep your fingers moving.  

Dressings

You will wake up with your hand in a bulky bandage.  This will be removed 2 or 3 days following the surgery by the hand therapy team.    There will be a dressing applied to the wound under this bandage.  These can occasionally come off and will need to be replaced during the first 2 weeks after surgery to protect the wound.  

The dressings are splash proof but not waterproof and so you should avoid getting them wet.

The wound is closed using non-dissolvable stitches.  These will be removed at approximately 10 days following surgery by the hand therapy team.  

You may be given a sling to help keep the hand up whilst walking about. This helps reduce swelling, but you can come out of it to move the shoulder and elbow.

Using the hand

You are encouraged to move the hand and wrist straight away in the dressings for light tasks. 

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able to swerve out of the way of something in the road.  This will vary between patients but normally is after the stitches have been removed.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” in about a week of your surgery.  If you have a more manual job it can take up to 6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable.  Your symptoms should be approximately 80% better by 3 months with the majority fully recovered by 6 months.  It can, however, take up to a year for some patients to fully improve.