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HealthInfo West Coast-Te Tai Poutini

Surgery for carpal tunnel syndrome

On the West Coast surgery for carpal tunnel syndrome is funded through the public system only if it is severe. Talk to your GP about whether you should see a surgeon. Not everybody who is referred to a surgeon will end up having surgery, but your GP may recommend a surgeon assesses you if you:

Carpal tunnel release (or decompression) is generally very effective. If there are signs your nerve is damaged, then surgery aims to stop it getting worse. It may not be able to completely reverse any existing damage. Some symptoms can get better immediately after the operation, but numbness can take longer to improve.

How is carpal tunnel surgery done?

The purpose of the surgery is to make more space in the carpal tunnel, which takes pressure off or releases your median nerve. This is done by making a cut in the palm of your hand near your wrist, and cutting a ligament on one side of the carpal tunnel – the transverse carpal ligament. The wound is then stitched up, and your hand is padded and bandaged.

It is usually done under a local anaesthetic injection, which numbs the area being operated on. Less often it is done under a general anaesthetic, which means you go to sleep.

You will be admitted to the Waterson Day Surgery Unit at Grey Base Hospital. Most people go home on the same day as their surgery, and don't stay in hospital overnight.

What can I expect from the surgery?

FDP injured wristPeople respond differently to the surgery, depending on how badly damaged their median nerve is.

The operation doesn't make the nerve instantly better, but it relieves the pressure on it. It's possible there will still be some pressure on the nerve and your symptoms might not fully go away. If this happens, the base of the palm of your hand may continue being numb.

If your nerve has just been irritated, not damaged, your symptoms of pins and needles will get better quickly. Pins and needles or numbness that happens only at night or when doing certain things usually gets better straight away.

If your nerve has been damaged, rather than just irritated, it will need time to repair itself. The numbness and weakness will continue, but should slowly get better over several months as the nerve heals. If your fingertips were numb they could take a year or longer to get feeling back, and may never fully recover.

Carpal tunnel syndrome comes back after the operation for about one in 20 people.

What are the risks and complications of carpal tunnel surgery?

All operations carry some risk, and it's important to talk about this with your surgeon before you decide if you want surgery. Tell them about any problems you have had with operations or healing, including reactions to medicines. The risks below are not the only risks but are the most common ones, or the most serious.

Specific risks of carpal tunnel surgery

You may have some pain around your scar for three to six months, but it's usually mild. However, it might be a problem when you're doing heavy physical work. This may affect how long it takes you to get back to work, as well as some of your everyday activities, but it usually goes away.

There is a risk the blood vessels or nerves that supply your fingers could be damaged. This could lead to more numbness or weakness, but it is very rare.

Occasionally, people get a lot of swelling or hand stiffness, and need long-term hand therapy to recover. And rarely a condition called complex regional pain syndrome (also called reflex sympathetic dystrophy) can develop after hand surgery. This can cause pain and swelling in your hand, which usually lasts up to a few months but may be permanent. This is treated with good pain relief and physiotherapy.

General surgery risks

Your wound may become infected, and you may need antibiotics, but this isn't common. You may bleed excessively, and you may develop a haematoma (collection of blood) that needs draining. Your wound may take a long time to heal. You may get what are called hypertrophic scars. These are tender, woody and thicker than normal scars. Tell your surgeon if you have had these in the past. You may have an allergy or reaction to the anaesthetic, which rarely, can be life-threatening.

On the next page: Before and after surgery for carpal tunnel syndrome

Information provided by the Canterbury DHB. Adapted by the West Coast DHB. Last reviewed April 2017.

Sources

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Review key: HICTS-12821