Having a Carpal Tunnel Decompression

Is an operation always necessary?
An operation to decompress the carpal tunnel provides excellent relief from symptoms of tingling and numbness, particularly night-time symptoms. Although carpal tunnel syndrome does not easily go away once you have it, it can grumble on with minimal symptoms for many years, and can also come in waves over time. Other options for management include:

– Doing nothing! People are usually very sensitive to changes in the pressure on the nerve, so if you have not much in the way of symptoms, then doing nothing is a great option. You can always come back if things get worse.

– Wearing splints. Night time splints usually partly relieve symptoms and this may make the condition easy to manage without surgery.

– Steroid injection. Steroid injections are known to reduce symptoms from carpal tunnel syndrome in the short term and are a good option for people who are keen to avoid surgery, or people who have presumed carpal tunnel syndrome with a normal nerve study.

What happens on the day of surgery?
On the day of the operation, you will be asked to report to the Day Surgery Unit at the Queen Margaret Hospital. Watch our introductory video here. You can expect to be in hospital for anything between 2 and 6 hours, depending on the list order.

What should you do to prepare?
The admission pack we send you contains a document called ‘Having an operation on your hand or arm‘. You can access this online by clicking here. This runs through most of the risks involved with the surgery, and it is really important that you are aware of this risk before agreeing to the surgery.

Planning for when you get home is also important. Although there are no restrictions on how you use your hand after the surgery, your hand will not work the way you want it to in the first few weeks after the operation. You can help make things easier by:

– Making sure you have a good weeks supply of food and provisions in the house
– Having some ready meals or easy prep meals available
– Planning to wear loose fitting clothing such as joggers and t-shirts for the first few days

What type of anaesthetic is used?
Carpal tunnel decompression is done under local anaesthetic, using a technique called WALANT surgery. The local anaesthetic usually lasts a few hours, then slowly wears off.

The anaesthetic is put in using a very fine needle in the anaesthetic room. Three injections are needed, but the first numbs the area of the second and third, so that you do not usually feel them.

The anaesthetic is designed only to numb the area of the operation and not the whole hand.

What exactly does the surgeon do?
The surgeon’s job is to divide the ligament at the base of the hand – the nerve runs underneath this ligament, and as soon as it is divided, the pressure on the median nerve is relieved.

At the end of the operation the surgeon will usually check the movement of the hand and then put a small dressing on the wound.

Is it safe to use the hand after the operation?
Although the operation divides one of the thick ligaments of the wrist, the stability of the hand and wrist is generally good, and it is quite safe to use the hand as normally as possible after the operation. We recommend that you keep the hand moving – touch your thumb to each fingertip in turn, fully straighten your fingers and then make a full fist around 10 times every half hour until your hand is working normally – this is for movement only, and you do not need to put any power into the fist!

What will the scar be like?
The scar is usually around 4cm long and quite tender to begin with. People often think that once the skin has healed the hand should feel normal, but because the surgeon has divided a thick ligament, it usually takes much longer for the hand to feel back to normal. As a rough guide:

2 weeks – Wound has healed. You should keep the wound clean and very dry until this point. It is usually safe to shower with the wound at 2 weeks, but wait until around 4 weeks before soaking it in a bath.

6 weeks – The scar is red and still tender. The area around the scar feels firm and tender. It is still uncomfortable to put pressure on the hand, and grip still feels weaker than normal.

3 months – Usually by 3 months, the hand function is back to normal, although you are still very aware of the hand when you are using it.

6-12 months – Over the next 6 months, the hand starts to feel normal again, and by the end of the year you will hopefully have forgotten about the operation.

What happens after the operation?
You will be discharged home within an hour or so of the operation. The hospital rules state that you have to be accompanied home, so you will need to ask a friend or relative to come and pick you up.

The nurses on the ward will arrange for the district nurse to remove the sutures, if you have sutures which need to be removed. We usually put you in charge from here on in – if you need to see us, you can contact us as you feel necessary. Click on this link to contact us.

Our Shared Care information sheet is available here.

The next time we get in touch with you is at 1 year – we will write and ask you to fill out our ‘outcome questionnaire‘ – as part of our hand audit. Please do fill this out for us, because it helps us to improve the service for patients.

When is it safe to drive after the surgery?
Remember that it is your responsibility to ensure that you are safe to drive by law! Most people return to driving at around 2-3 weeks after their operation. There is further guidance on this in our ‘Having an operation‘ guide.

When is it safe to work after the surgery?
There are no restrictions on how you use your hand after the operation, so if you have a desk job you can potentially go back to work straight away. Most people with light manual jobs go back at around 4 weeks, and heavy manual workers might need longer than this.

© Fife Hand Service 2022

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