Carpal Tunnel and Nerve problems

What are the Symptoms of Carpal Tunnel Syndrome?

Pressure on the median nerve in the carpal tunnel can cause symptoms such as tingling in the hand, numbness, a decrease in function or aching. The tendency towards carpal tunnel syndrome may be present in some families. Carpal tunnel symptoms may develop slowly over time but may accelerate after an injury, during pregnancy, as a consequence of diseases such as rheumatoid arthritis and with repetitive use.

Sometimes medications like anti-inflammatories or splinting the hand will relieve the problem, however if this treatment isn’t successful you may require surgery. Carpal tunnel release is best performed before numbness and weakness are present all of the time, but surgery can help prevent worsening of symptoms at any stage of the condition.

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What Does Carpal Tunnel Surgery involve?

The aim of carpal tunnel surgery is to release fibrous tissue that is putting pressure on the nerve.

The surgery’s success will depend on how long the condition has been present and the amount of damage to the nerve. You should speak to a specialist plastic surgeon as soon as you think you have carpal tunnel syndrome.

Recovery and Rehabilitation

What happens after carpal tunnel surgery?

Your wrist may be uncomfortable after surgery. Elevation of your hand in a sling will help limit the discomfort across the first few post-operative days. Your surgeon will prescribe pain medication to help keep you comfortable during this period.

For the first week or two post-surgery you will wear a firm bandage or something else to support your wrist and hand. Your surgeon will share tips to aid your recovery, such as moving your fingers to help relax your muscles when you’re feeling stiff, or elevating your hand during the night to help with inflammation.

You will need a follow-up appointment where your surgeon will remove your bandage. You will also need physical therapy sessions where the therapist will share exercises to help strengthen your hand.

For a period of time after your surgery you may need to alter your tasks at work as your movement will be restricted and you may need to wear braces or splints. The release of fibrous tissue in the surgery may make it uncomfortable for you to put direct firm pressure over the surgical site for some months until your wrist adapts. This usually goes away by itself.

Immediately speak to your RPS team if you have fever, severe pain, bleeding, swelling or other signs of infection.

More information

What else you should know

When is carpal tunnel surgery needed?

There are many non-surgical options to manage carpal tunnel syndrome. These include night splints, corticosteroid injections, pain relief or other therapies. Depending on the severity of your condition, these are typically trialed first to determine whether surgery can be avoided for you. Your surgeon will follow your response carefully to determine whether these are working sufficiently that surgery can be avoided. A Nerve Conduction Study may aid your surgeon in following your progress over time.

In moderate to severe cases or when non-surgical options are not effective, surgery is a good method to remove pressure from your nerve. When both hands are affected, the most affected hand is operated on first while non-operative management options are used on your other hand while you are recovering from surgery. The second hand can then have surgery once your first hand has sufficiently recovered.

If these interventions don’t work, the pain becomes worse, or the symptoms persist for six months, the electromyography test results may show that you need surgery.

What are the potential complications of carpal tunnel surgery?

Carpal Tunnel Release is very well-tolerated by the vast majority of patients with few side effects or complications.

As with every surgery, carpal tunnel surgery does have risks.

It’s normal to experience headaches or a sore throat or other aches after the anaesthesia.

During the surgery there is a risk of bleeding, scarring, injuries to the wrist’s nerves or blood vessels and infection. Once healed, it is not uncommon for direct pressure over the wound to be uncomfortable for some months, but this usually goes away by itself.

With any surgery on nerves, there is a risk of an uncommon pain syndrome called Complex Regional Pain Syndrome (CRPS) following surgery. We are not able to predict which patients will develop this condition and it is not typically related to a problem during surgery. In CRPS, non-painful sensations can be sensed as pain starting some weeks following the surgery when things should be settling down well. Some patients feel normal sensations (a light breeze on their hand) as uncomfortable or painful and may find it very painful for the hand to be touched. Knowing that this can happen is important so that treatment can begin early, to limit the severity of the condition and how long it is present. Most cases of CRPS resolve with time and multimodal management (including a Pain specialist, your GP, a hand therapist and others as required).

How will RPS manage my post-operative care?

Your RPS surgeon will give you specific advice regarding your individual post-operative recovery. They will advise: