CARPAL TUNNEL RELEASE
Carpal Tunnel Release
Under local anaesthesia injection, the surgeon makes a cut over the front of the wrist. The tight ligament over the nerve is released, so that the median nerve has more space in its tunnel. The skin is then stitched up usually with non-dissolvable sutures. A splash proof dressing and supportive bandage is applied and the patient’s arm(s) elevated. CTR can be performed on both sides at once. This is a decision between the patient and the surgeon.
Surgery for carpal tunnel syndrome is recommended if:
- Non-operative treatments fail: If symptoms persist despite trying conservative measures.
- Severe symptoms are present:
– Persistent numbness or tingling in the fingers.
– Muscle weakness or visible wasting of the thumb muscles (thenar eminence).
– Significant pain that interferes with daily activities or sleep.
Overview of Carpel Tunnel Release surgery
This procedure, typically performed under local anaesthesia, relieves pressure on the median nerve by releasing the carpal tunnel’s transverse ligament. It is minimally invasive and done as a day case/outpatient procedure. Here’s a step-by-step outline of the procedure:
1. Local Anaesthesia
The area is numbed using a local anaesthetic injection to prevent pain during the surgery. There may be mild discomfort during the injection.
2. Tourniquet
A tourniquet may be applied to your upper arm to temporarily restrict blood flow. This helps reduce bleeding and ensures a clear surgical field.
3. Incision and Ligament Release
A small incision is made at the wrist. The transverse carpal ligament is carefully divided to relieve pressure on the median nerve.
4. Sutures
The incision is closed with either dissolvable or non-dissolvable stitches, depending on the surgeon’s preference. Dissolvable stitches typically don’t require removal.
5. Dressing and Bandage
A splash-proof dressing and supportive bandage are applied to protect the surgical site and reduce swelling.
Before Surgery
- No fasting required
As the surgery is done under local anaesthesia, fasting is not necessary. You can eat and drink normally before arriving. If you are having a General Anaesthesia (going to sleep) then will need to fast for at least 6 hours. - Avoid smoking
Smoking can interfere with the healing process and increase the risk of complications. Please avoid smoking for at least 12 hours before surgery. - Continue Medications
You should continue your regular medications, including blood thinners (like aspirin or warfarin), unless instructed otherwise by your surgeon. Inform the surgical team about any medications or supplements you are taking.
On The Day of Surgery
- Arrival and Registration
Report to the hospital’s main reception upon arrival. You will be shown to your room where the nurse will check in and you will meet with Prof. Singh and the anaesthetist. - Pre-Surgery Consultation
Take this time to ask any last-minute questions about the procedure. The anaesthetist (if having a GA) will review your medical history and explain the anaesthesia plan, while the surgeon will go over the steps of the surgery. - Surgical Timing
You will be given an approximate time for your surgery, though there may be some delays, so be prepared to wait. - Preparation Instructions
Please read the Preparing for Surgery instructions to understand what to expect before, during, and after the procedure.
What Are The Possible Complications?
While rare, complications may occur after surgery:
1. Infection
Infection is a small risk (less than 1 in 200). Symptoms include redness, warmth, swelling, or discharge at the incision site. Infections are usually treated with antibiotics.
2. Scar Formation
A small, approximately 2 cm scar will form. This may be tender for the first few weeks. Moisturizing the area with cream can help reduce tenderness and improve the scar’s appearance.
3. Neuroma
Rare nerve injury during surgery could cause a painful spot at the incision site. In such cases, further surgery may be required.
4. Stiffness
Some stiffness may occur post-surgery as the tendon adjusts. This usually improves with time and gentle stretching.
5. Chronic Regional Pain Syndrome (CRPS)
In rare cases (less than 1 in 50), swelling, pain, and stiffness may persist after surgery, requiring additional treatment like physical therapy or pain
management.
6. Tendon Damage
There is a very small risk of tendon damage during surgery, though it’s typically minor and may be due to the condition itself. Major tendon issues are uncommon.
7. Incomplete Recovery
Preexisting nerve damage may limit full functional recovery.
After Carpel Tunnel Surgery
After Surgery:
1. Sling
You will be fitted with a high arm sling, which should be worn for 48–72 hours to help reduce pain and swelling.
2. Wound Care
Keep the wound clean and dry. The large bandage can be removed 24–48 hours after surgery, but the wound should stay dry until the sutures are removed. You may change the dressing as needed.
3. Pain Management
The local anaesthetic typically lasts 4–8 hours. Take painkillers before the anaesthesia wears off, and continue taking them for at least 24 hours post-surgery or as needed.
4. Suture Removal
Sutures need to be removed around 14 days after surgery. This can be done by your GP or at the hospital. Confirm arrangements with the ward staff before discharge.
5. Use of Hand After Surgery
You can begin using the fingers and hand for simple tasks as you feel comfortable. Avoid heavy work for at least 2 weeks or until the wound is fully healed.
6. Follow-Up Appointment
A follow-up consultation will be scheduled 2–4 weeks after surgery to monitor recovery and address any concerns.
7. Physiotherapy
Physiotherapy is generally not needed, but if there are any issues with movement or stiffness, it can be arranged. After the wound heals (usually 2 weeks), gentle massage of the scar with soft cream 2–3 times a day for 2–3 months is recommended to promote healing and minimize scarring.
8. Return to Work
– Sedentary work: 1–2 weeks.
– Light manual work: 2–4 weeks.
– Medium manual work: 4–6 weeks.
– Heavy manual work: 6–8 weeks. Discuss your specific work requirements with your surgeon to determine the right time for you to return.
9. Driving
You can resume driving when you feel comfortable and confident in controlling the vehicle. Ensure you can perform an emergency stop and that you are safe in the vehicle. Start with short drives and check with your insurance if in doubt.