Carpal Tunnel Release
Symptoms, surgery, and post-operative care
What is Carpal Tunnel Release?
Carpal tunnel release is an intrinsic surgical procedure that is carried out to help provide relief for patients diagnosed with CTS (Carpal Tunnel Syndrome).
CTS is a hand and wrist complaint that is caused when swelling occurs in hand affecting the tissue in the carpal tunnel. This swelling places pressure on nerves (in particular the median nerve) and tendons that bend the fingers, which causes the most discomfort and pain.
Symptoms and swelling can often start off slow and gradually get worse over time if left untreated. Most patients will also experience more pain on the thumb side of the hand.
Unfortunately, CTS is believed to be a condition that runs within families as well as being caused by injuries to hands through sprains, fractures, and repetitive use of vibrating tools.
It’s also important to be aware that pregnancy, diabetes, thyroid disease, and rheumatoid arthritis can also cause CTS.
Symptoms of Carpal Tunnel Syndrome
The symptoms and signs of CTS can include:
- Numbness in hands and fingers
- A tingling sensation similar to pins and needles
- Consistent pain/dull ache across the hand
- Pain that mainly affects the thumb, index and middle fingers
- Swelling in the fingers, which increases during the night.
Many patients find that symptoms are worse at night, and this is because your body is relaxed and still so stiffness in the hands and fingers can occur. This is why you will find that shaking your hands offers a small relief to some of the symptoms mentioned above.
We understand that CTS can impact your everyday life, so we know how vital surgery can be to you.
That’s why we will meet with you and discuss in detail the process that we will carry out as well as pre and post-op care.
It’s also an excellent opportunity for you to meet the team and have your questions answered, putting your mind at rest that your hands are most definitely in the right hands.
At The Manchester Hand Surgeon, we will always take the time to discuss alternative treatments with you and non-surgical routes if applicable.
Taking into consideration remedies such as painkillers and splints, which can often help in the short-term (resting splints can also be particularly beneficial at night).
As well as steroid injections into the carpal tunnel, which can also help to alleviate symptoms and provide you with a lot more comfortable as you go about your day to day activities.
If carpal symptoms are apparent during the last trimester of pregnancy, a splint or steroid injection can be offered; as in these cases, we often find that most symptoms will resolve themselves a few months after the baby is born.
Of course, non-surgical routes do only provide a temporary solution.
Carpal tunnel surgery is typically a day case procedure, where you will come into our surgery, have your operation, and go home on the same day. Offering you complete convenience. There’s no need to pack an overnight bag or make any longer-term arrangements while you’re away.
The operation itself will involve dividing a ligament in your wrist to relieve the pressure on the nerve that controls movement and feeling in your hand.
Traditional surgery will involve up to a 2-inch incision in the palm and wrist area.
Endoscopic surgery will involve one or two half-an-inch incisions and the use of an endoscope.
Both surgeries will be carried out under local anaesthetic. This means you will be awake during the operation, but you won’t be able to feel anything, and we will throughout continue to make sure you’re comfortable and at ease.
During the surgery itself, we will dissect the transverse carpal ligament, which will relieve the pressure on the median nerve and in turn, enlarge the carpal tunnel. Releasing the pressure and tension that has been causing the pain.
Our specialist hand and wrist surgeons will work with you, your symptoms, and medical conditions to provide you with the best and most suitable options for you.
Treated like individuals always, we recognise that everyone suffering from carpal tunnel syndrome is different and, as such we tailor surgical plans and care accordingly.
With any local anaesthetic, it can take a few hours for the feeling in your hand and wrist to come back fully.
As it begins to wear off, you may feel a tingling sensation in your hand and fingers, and this is entirely normal.
It is essential to take extra care not to knock your wrist or hand immediately after surgery and be overly cautious around hot items such as radiators and kettles.
Your post-operative care will also involve bandages and splints which, should be worn for the first 1 to 2 weeks after surgery. We advise the splint, in particular, to be worn as much as possible to help raise the hand and reduce any swelling post-surgery.
We’ll arrange a follow-up appointment with you to remove all bandages and splints, and check on the incision and ensure the hand is healing how it should be.
We’ll also provide you with a small set of exercises to encourage you to move your fingers, helping to prevent stiffness and additional swelling.
It is normal for scars to feel a little tender after surgery, but this will settle down after a few months, with your scar looking visibly better within three months. Creams such as E45 cream can help to stop any itching and dryness surrounding the scar.
The good news is that you will typically notice a considerable difference in around four weeks post-surgery, where you will be able to increase your hand’s activities ( while still avoiding heavy and repetitive activities).
Some of our most common post-operative practices to help speed up recovery and avoid further complications include:
Keeping the hand elevated above heart level
Wearing a splint while resting
Using ice packs for the hand and wrist to help reduce swelling
Keeping the surgical incision clean and dry (covering the area while bathing or showering is essential)
Physical therapy (will be discussed further with you at your follow up appointment, helping to restore strength and functionality)
Promoting a faster healing process by maintaining a healthy diet and not smoking.
Getting back to your everyday activities
Everyone responds to surgery differently.
Typically, recovery time is between 3 and 4 months. However, it can take up to a year before your strength and power return in your hand. Again, how much strength returns will vary from patient to patient. This is why we will always advise patients to take it easy immediately after surgery.
Returning to work
You may need time off to recover after your hand surgery. Many people find that they’re good to go back to work on light duties after 12 days; some feel sooner, and again this is all dependant on the individual and the type of job you do, however, don’t put too much strain and stress on your hands straight away. Things such as typing, lifting a telephone, or heavy items should be limited.
We would recommend returning to full working activities after approximately 19 weeks.
Your grip will return to normal typically between week six and week 12.
It’s important to remember that every human body and hand is different, and everyone’s recovery time will vary; you should be guided by how you feel.
You won’t be able to drive straight after surgery, so we do advise that you have someone with you who can take you home or ensure that you have prior arrangements in place. You also don’t have to inform the DVLA about your surgery (unless in very rare cases where recovery is going to take longer than 12 weeks, but your surgeon will discuss this with you and answer any of your questions).
It’s important, however to check with your insurance company, as some policies have a disclosure stating that you are not covered for a certain period after any surgery, so we’d advise all of our patients to check their policies.
Before you get behind the wheel, you should:
- Be able to grip and control the steering wheel appropriately
- Be able to sit comfortably and at ease
- Be able to perform an emergency stop
- Have full feeling back in your wrist and hand
- Make sure you have no pain or discomfort while driving
- Ensure any medication or painkillers don’t make you drowsy
- You can move your wrist and hand adequately in order to drive
- Start with short journeys
Risks and Complications
For the majority of patients, no complications following carpal tunnel surgery will occur.
However, common with any surgery are side effects such as patients suffering from pain, infections, scarring, and potential nerve damage. This can lead to weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.
Your surgeon will be able to discuss and talk through all of this with you during your appointment, helping to put your mind at ease and answer any of your questions further.
Hand and wrist treatments tailored to you.
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