Southend University Hospital NHS Foundation Trust Patient Information Service Carpal tunnel decompression advice SOU1277_120995_1018_V2.indd 1 28/11/2018 09:16
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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 09:16
Carpal 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 09:16
If 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 09:16
Driving 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 09:16
What 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 09:16
Exercises 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 09:16
From 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. 8 SOU1277_120995_1018_V2.indd 8 28/11/2018 09:16
If 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 09:16
Southend 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 09:16