Carpal tunnel decompression advice - Southend University ...
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Southend University
Hospital
NHS Foundation Trust
Patient Information Service
Carpal tunnel
decompression advice
SOU1277_120995_1018_V2.indd 1 28/11/2018 09:16SOU1277_120995_1018_V2.indd 2 28/11/2018 09:16
Carpal tunnel syndrome
The carpal tunnel is formed by the bones of the wrist, which
form a ‘U’ shape with the palm upwards, and a strong ligament
across the top. Running through the tunnel are nine tendons,
which connect muscles in the arm to the bones of the hand, and
the median nerve. This nerve supplies power to the muscles at
the base of the thumb, and sensation to the thumb and first
three fingers of the hand.
Median nerve
Transverse ligament
Carpal bones
Flexor tendons
If there is any swelling in the wrist this can compress the nerve,
leading to pain, numbness and tingling. The symptoms are
mainly felt at night and first thing in the morning, but also may
be brought on by positions such as driving or holding a book.
1
SOU1277_120995_1018_V2.indd 1 28/11/2018 09:16Carpal tunnel decompression
The operation can be performed under local or general
anaesthetic (fully asleep).
The surgeon will make a small cut in the palm of the hand and
will then cut the tight ligament to relieve the pressure on the
nerve. The surgeon closes the wound with stitches.
Benefits
The operation will reduce pressure on the nerve, which will
relieve the symptoms you have been experiencing. It must
be noted, in some cases it can take six months to a year for
symptoms to continue to improve.
If compression of the nerve is severe, the nerve may become
permanently damaged. This could cause muscle wastage in the
thumb and permanent numbness in the hand. Surgery at this
stage will not reverse the damage.
What to expect after your surgery
• The operation should relieve the pain in your wrist fairly
quickly, although you will of course have some local soreness
from the incision
• The symptoms of pins and needles and numbness may not be
relieved immediately following surgery. This may take many
months, and in some cases may not fully return to normal
2
SOU1277_120995_1018_V2.indd 2 28/11/2018 09:16• Some people experience an achy pain on either side of the
wrist. This is called ‘pillar pain’ and is quite normal. It should
resolve over six to nine months
• Normal grip strength can take up to a year to recover.
Your wound
You will have a small cut in the palm of your hand. This will
be covered by a dressing and a bandage, which you must
keep clean and dry. Your named nurse will give you specific
instructions on when this can be removed, depending on your
surgeon’s instructions.
Remove bandage yourself in ………….. ………….. days
Remove dressing yourself in ………….. ………….. days
Bandage and dressing to be removed in clinic on …………..
Stitches to be removed at your GP surgery in ………….. days
Dissolvable stitches ( )
When the bandage and dressing have been removed you can
then have a shower. Clean the area daily to aid the dissolving
of stitches after seven days. If you have stitches that dissolve do
not soak your hand in the bath as this will make them dissolve
too quickly. These stitches should dissolve within 14-21 days. If
you have stitches which need to be removed, this can be done at
your GP surgery. Please make this appointment yourself.
3
SOU1277_120995_1018_V2.indd 3 28/11/2018 09:16If you experience increased pain, swelling, redness or discharge
(weeping) from the wound you may have an infection and you
should make an urgent appointment to see your GP.
Elevation
You should elevate your hand as much as possible whilst it
remains swollen. A sling will be put on before discharge from
hospital. Please use this only until the bandage is removed. You
are advised to remove the sling on a regular basis to allow you
to exercise your wrist, elbow and shoulder to prevent stiffness.
Whilst resting you are advised to elevate your hand on pillows
(ideally your hand should be higher than the level of your
heart).
Pain or discomfort
If you are having a general anaesthetic you will be given
painkillers and anti-sickness medication during your procedure
to make sure you are as comfortable as possible.
You will be offered painkillers to take home with you. Take as
directed (please note you will be charged for these if you pay for
prescriptions). You may take your own painkillers if you prefer.
If you wish to purchase these prior to your operation, please ask
your pharmacist for advice.
4
SOU1277_120995_1018_V2.indd 4 28/11/2018 09:16Driving
Avoid driving until the wound is healed, usually around two
weeks, then start with a short journey if you feel safe to do so.
Please contact your insurance company for specific advice.
Work
Your surgeon will advise you when you can return to work.
This will depend on the type of work you do. Avoid strong grip
until six to ten weeks after your surgery. Most cases will require
between two to six weeks off work. If you require a medical
certificate please ask your named nurse on admission.
5
SOU1277_120995_1018_V2.indd 5 28/11/2018 09:16What to do after your surgery
First day
• Dressing – Keep dressing dry and clean
• Elevation – To reduce swelling keep the hand raised as much
as possible between exercises
• Exercises – To be performed five times each, five times a day
within limits of the dressing
1. 2.
3. 4.
• Shoulder exercises – Reach as high into the air as you can and
hold for five seconds. Repeat ten times
• Elbow exercises – bend and straighten your elbow.
Repeat ten times.
6
SOU1277_120995_1018_V2.indd 6 28/11/2018 09:16Exercises days 3-5
• Exercises – Once the bandages are removed perform the
following exercises five times each, five times a day.
1. 2.
3. 4.
7
SOU1277_120995_1018_V2.indd 7 28/11/2018 09:16From one week onwards
• Gradually increase the use of your hand
• Continue with your exercises until movement is the same as
your other hand
• When stitches are removed or dissolve, you should massage
the scar lightly with a low allergy cream, eg aqueous cream.
Massage daily for five minutes at a time to soften the scar,
reduce swelling, and reduce sensitivity and pain.
Complications
• Infection – as with any surgery there is a small chance of
the wound becoming infected. If the wound becomes red,
swollen, hot or starts to weep please see your GP as soon as
possible, you may need antibiotics. Otherwise please phone
the dressing clinic on: 01702 435555 ext 5395
• Tenderness – it is common to experience tenderness around
the scar, this could last several months, this can be helped by
gentle massage as described
• Numbness – caused by damage to a nerve, which may be
temporary or permanent. Permanent damage is rare
(risk 1 in 600)
• Severe pain, stiffness and loss of use of the hand (Complex
Regional Pain Syndrome) – this is extremely rare and the cause
is unknown. You may require further treatment, including
physiotherapy. If you experience any of these symptoms
please contact hand therapy on: 01702 435555 ext 6707.
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SOU1277_120995_1018_V2.indd 8 28/11/2018 09:16If you have any specific concerns regarding these complications
please discuss this with your surgeon.
If you require a follow-up appointment in the outpatient clinic
your named nurse will inform you on discharge.
If you have any concerns please telephone the day surgery unit
on 01702 385053 (direct line) or 01702 435555 ext 6158 or your
own GP.
If you have any questions relating to the exercises please
telephone the hand therapy team on 01702 435555 ext 6707.
9
SOU1277_120995_1018_V2.indd 9 28/11/2018 09:16Southend University
Hospital
NHS Foundation Trust
Patient Information Service
If this leaflet does not answer all of your questions, or if you
have any other concerns please contact the day surgery
on: 01702 385053.
www.southend.nhs.uk
For a translated, large print or audio tape version
of this document please contact:
Patient Advice & Liaison Service (PALS)
Southend University Hospital NHS Foundation Trust
Prittlewell Chase
Westcliff-on-Sea
Essex, SS0 0RY
Telephone: 01702 385333
Fax: 01702 508530
Email: pals@southend.nhs.uk
Written by the surgery and hand therapy teams
Reviewed and revised October 2018
Leaflet due for revision October 2020 Form No. SOU1277 Version 7
SOU1277_120995_1018_V2.indd 10 28/11/2018 09:16You can also read
