Carpal Tunnel Surgery

– Pins and needles / tingling / numbness
This can affect the whole hand but usually the little finger is spared. It is often worse at night causing you to wake and can come on with certain activities such as driving or reading a newspaper. The fingers may also feel swollen at times. You may find you can relieve these symptoms by shaking the hand or by hanging it out of bed or down by your side.

– Pain
This may be a general ache around the wrist or shooting pains down the fingers. The pain can also spread up the arm.

– Weakness
This may be noticed with certain tasks e.g. unscrewing jar lids. If the condition gets worse the muscles at the base of the thumb may become weak and start to ‘waste away’.

– Persistent numbness
Affecting the fingertips is another sign of the condition getting worse, it may be noticed when trying to do fine tasks e.g. doing up buttons or sewing.

Often it is unclear why the problem has occurred. Inflammation in the tendons running through the tunnel will compress the nerve. This can occur with over use and repetitive movements of the wrist. Carpal Tunnel Syndrome is more common in manual workers and when vibrating tools are used.

Arthritis and wrist fractures can narrow the tunnel causing compression of the nerve. Other conditions that are associated with Carpal Tunnel Syndrome include an underactive thyroid gland, diabetes, obesity and pregnancy (symptoms usually resolve some time after delivery). Any other problems would be rare.

It may be necessary to perform some simple nerve tests if your symptoms are not typical of Carpal Tunnel Syndrome. This involves a very small electrical current being passed across your wrist to test the conduction along the nerve at this point. The tests are at worst mildly uncomfortable.

A wrist splint can help night time symptoms. This may be all that is necessary as symptoms of CTS can resolve without any further treatment. However, once symptoms have been present for more than a few months, it is likely that some form of treatment will be necessary.

A steroid injection in the wrist can be useful, particularly if symptoms have only been present for a few months and there is no loss of sensation to the fingertips, or loss of the muscle at the base of the thumb. This could be done at your first appointment. Symptoms often recur after a steroid injection.

An operation is often required for a permanent solution. If this is needed we will make you a further appointment (please bring your diary with you). Other treatments such as physiotherapy and ultrasound can be used but there is little evidence of their value. Acupuncture can help with pain.

The following is for your information if you do go on to have an operation.

On the day of your operation you can eat and drink normally and take your usual medications. Please wear something with loose fitting sleeves and remove any rings on the hand that is to be operated on. If you would like to listen to some music during the operation please bring a favourite CD. You will need someone to drive you home and will be with us for less than an hour.

The operation requires the palm of the hand to be numbed with local anaesthetic, which is very effective. The basis of the operation is to divide the ligament which forms the ‘roof’ of the tunnel. The operation takes less than half an hour. Four skin stitches are usually required. The hand is wrapped in a crepe bandage.

For the first twenty-four hours you need to keep the hand elevated. A pile of pillows when sitting or sleeping can be useful; this helps to keep swelling down and prevents bleeding.

The local anaesthetic will start wearing off after a few hours. Please start taking the painkillers we provide before then, and regularly for the first two days. Later (after four hours) on the day of your operation, gently bend and straighten the fingers and thumb every hour or so.

The next day you need to fully straighten and bend them, for at least five minutes every hour, this is very important and prevents them becoming stiff and painful.

The day after the operation you can start using your hand for light tasks. The hand will feel weak and be a little sore but the more you use the hand the quicker the recovery will be. You should take the bandage off yourself after three days, leaving the small dressing on. Try to keep your hand dry until the stitches come out at ten days, you will need to make an appointment with your own practice nurse for this. When the stitches are taken out you will notice the skin is scaling, and the scar is red/ purplish, thickened and tender to touch. This is quite normal. Again it is important to use your hand as much as possible.

If you have any problems after your operation and need medical advice please call our after-care line. This will be available until 6.30pm the day after your operation. In the case of a medical emergency you should always call 999 for an ambulance.

We will not arrange to see you again as this is usually not necessary. However if you do need to see or talk to us again, please call the appointment line
number. Both these numbers will be given to you on the day.

Some people can do fairly hard labour after only a few weeks. However, it can take two to three months to regain full strength. The time off work will usually vary from a few days to a few weeks. Please ask for a medical certificate if needed.

The majority of patients having carpal tunnel surgery are very satisfied with the outcome. A small number of patients do not get complete resolution of their symptoms. It would be rare for symptoms to be worse following surgery. Please ask how this relates to your symptoms.

It is most unusual for symptoms to recur, reported rates vary from 1/200 to 1/300. A second operation can be performed.

– Uncommon
As with any operation, there is a small risk of infection. This would normally require a course of antibiotics. The risk is 1-2%.

The scar usually heals very well. There is a small risk or it remaining sensitive and occasionally a patient may not be happy with its appearance.

– Rare
Complex Regional Pain Syndrome affects approximately 1 in 250 patients, usually female. This condition does not only occur after this type of surgery, it can occur after any injury or insult to a limb. In the weeks following the surgery, the hand becomes very painful and the fingers stiff and swollen. It can take many months for improvement in the condition with regular visits to a physiotherapist. Undertaking regular finger exercises as discussed helps to prevent this problem.

Pillar pain, which is pain around the scar with heavy physical use of the hand can affect those with heavy manual jobs. Damage to the superficial branch of the median nerve supplying the palm. This would cause loss of sensation in this area and could also cause ongoing pain in the palm. Damage to the motor branch of the median nerve supplying the thumb. It is not usually possible to reverse this damage; this would leave the thumb permanently weak.

The majority of patients will not suffer any complications

1. Any local anaesthetic allergy.
2. Any latex allergy.
3. Implantable defibrillator.
4. 2 week wait referrals for cancer care.
5. Patients aged <18 years.
6. Patient weighing over 135Kg.
7. Patients who are detained under the Mental Health Act or are experiencing an acute psychotic episode.
8. Patients being detained by Her Majesty’s Prison Service, where security arrangements are deemed not to be appropriate.

NB We should also only treat patients who are deemed suitable for local anaesthetic treatment in the community and who prefer local anaesthetic over a general anaesthetic.