Carpel Tunnel Surgery

Introduction

At the junction of the forearm and the palm of the hand, 9 tendons and a nerve (median nerve) travel through a tunnel which consists of small bones of the wrist and a ligament (transverse carpal ligament).

In carpal tunnel syndrome, there is not enough space and the median nerve gets compressed. Symptoms include tingling and numbness in the palm and the fingers which can radiate up the arm. These symptoms often start and night but can progress to daytime. In severe cases, there may be weakness of the hand.

Indications for surgery

Dr Lane can usually make the diagnosis of carpal tunnel syndrome on clinical history and physical examination. This diagnosis can be confirmed with a nerve conduction study. However, as much as 20% of patients may have a normal nerve conduction study.

The treatment of carpal tunnel syndrome depends on the severity and patients’ expectations and wishes. If the symptoms are mild and usually occur at night, Dr Lane may refer to a hand therapist for a splint that can be worn at night.

 If your symptoms persist despite conservative, non-operative measures then surgery is indicated. Dr Lane offers open surgical technique to relieve the nerve compression. At the time of consultation, Dr Lane will provide comprehensive information about your proposed surgery, surgical risks and after-care.

Pre-operative Instructions

Anti-inflammatory drugs such as Feldene, Naprosyn, Indocid, Voltaren, Mobic and Celebrex should be stopped 5 days before surgery. These drugs increase the risk of bleeding. Aspirin or other blood thinning drug use prior surgery should be discussed with Dr Lane as this would depend on the patients underlying medical condition. The hand to be operated on should be free of cuts, abrasions or sores as this would increase the risk of infection following surgery. If you have damaged skin, your surgery will be postponed until healed.

Carpal tunnel surgery is done as a day procedure. The reception staff will advise you of your admission time at your preferred hospital. Please take your Medicare, DVA or private health care cards and do not eat or drink 6 hours before your surgery.

Once your details are taken at the admissions desk:

  • You will be admitted by the duty nurse and baseline observations taken.
  • Theatre gown is given to wear.
  • The hand will be inspected by the nursing staff and antiseptic lotion applied to the skin. The hand is then covered with a sterile drape.
  • You will be given TED stockings to wear on your legs to reduce the risk of thrombosis following surgery.

You will be taken from the Day Hospital to the Theatre Complex by the nursing staff and then to the Anaesthetic Bay next to the operating room. There you will meet your anaesthetist and Dr Lane.

Procedure

Surgery can be performed under local anaesthetic with twilight sedation or general anaesthetic. Once in theatre, a tourniquet is applied to the upper arm to give a bloodless field for surgery. The hand and forearm are washed with antiseptic solution and sterile drapes covers the patient with a window for the operating site. 

A three-centimetre (approx.) incision is made from the wrist crease towards the fingers in line with the thumb side of the ring finger. After dissecting down to the fibrous band (ligament) that is compressing the nerve, the nerve is released. Care is taken to completely decompress the nerve. The skin is then sutured and local anaesthetic injected around the wound site to aid post-operative pain relief. The wound is then covered with primapore and dressings and a bandage applied. The operation takes about 15 minutes. 

After surgery, you will be taken to the recovery area. Once adequately awake, observations normal and are able to eat and drink, you will be discharged home. It is important that you have someone take you home. You will be given a script for pain relief medications.

Post-operative Instructions

The outer dressing and bandage should be kept dry but can be removed after 5 days, leaving the primapore in place. The remaining wound dressing should be kept dry until seen by Dr Lane in his rooms about 14 days after surgery. At this time, your sutures will be removed and Dr Lane will advise on recovery activities- heavy duties to be avoided for the next 4 weeks. Your hand will let you know if you are overdoing it.

Risks

General risks associated with Anaesthetic (rare)

  • Death.
  • Myocardial Infarction.
  • Stroke.
  • Deep venous thrombosis.

Local risks (uncommon)

  • Infection.
  • Bleeding.
  • Pain reaction called Complex Regional Pain Syndrome (CRPS).
  • Scarring.
  • Incomplete decompression.

Patients who are smokers, diabetic and have multiple pre-existing medical conditions are at a higher risk of adverse complications.