Orthopaedic Clinic: Hand and Wrist
CARPAL TUNNEL RELEASE
Carpal tunnel syndrome can be caused by pressure on the median nerve at the wrist, which can lead to pain and weakness in the hand. The median nerve supplies feelings to the thumb, first two fingers, part of the third finger and also to some of the muscles of the hand.
The carpal tunnel is composed of two "walls" - the deep wall comprises the bones of the wrist and the superficial wall is a thick ligament located just under the skin on the palm side of the wrist. The median nerve and the tendons that flex the fingers to form a fist, pass through this tunnel.
Certain conditions such as wrist fractures, inflammatory conditions, rheumatoid arthritis repetative strain syndrome can cause swelling in the carpal tunnel. Sometimes there is no identifiable cause. The walls of the tunnel are rigid and cause the swelling to increase pressure on the nerve. Nerves are very sensitive to pressure and when the median nerve is pressed, the muscles it supplies become weak and the skin over the thumb, index and middle fingers becomes painful, tingly, or even numb.
THE OPERATION
Carpal tunnel surgery involves 1 or 2 small incisions in the palm of the hand. The surgery can be performed endoscopically (using a small camera attached to a monitor). The carpal ligament is directly below the incision(s), in the area of the palm just past the wrist in the direction of the fingers. This ligament is cut in line with the arm which releases the pressure on the nerve passing through.
FOLLOWING SURGERY
Local anaesthetic is injected around the site of the operation and this area and the nearby fingers may remain numb for up to 10 hours following surgery.
Hand elevation is important to prevent swelling and stiffness of the fingers. It is important not to walk with your hand dangling or to sit with your hand held down in your lap. Hand movement should be continued and you should perform normal light activities during the post-operative period.
You will be discharged with a bulky dressing consisting of gauze, wool and a crepe bandage which should be removed after five days. The wound is usually slightly bruised and swollen, but there shouldn’t be any signs of redness or tenderness, indicating infection.
At ten days it is safe to get the hand wet in the bath or shower. The wound and surrounding skin often become very dry and will be more comfortable if a moisturiser such as E45 is applied to the hand including the wound itself.
There are a number of exercises to prevent stiffness:-- straightening the fingers completely.
- making a claw and a fist with the fingers.
- spreading the fingers as wide as possible.
- touching each of your finger tips in turn with the tip of your thumb.
If you have regained full movement and are comfortable you may drive a car after a week.
Timing your return to work will depend on your occupation and you may wish to discuss this with your surgeon.
Complete recovery can take anywhere from several weeks to twelve months depending on the severity of damage to the nerve. The longer the symptoms lasted before surgery, and the more severely damaged the nerve appears at surgery, the longer the recovery time.
