Treatment of Carpal Tunnel

There are a number of ways of treating the condition including activity modification, splinting, anti-inflammatory drugs, steroid injections and surgery.

Surgery is recommended if you have had the problem for a long time, your symptoms are severe, non-surgical treatments have failed or, if the doctor detects wasting of muscles or loss of sensation in the hand.

Surgery offers the best chance of short and long term relief compared to other forms of treatment. Surgery for Carpal Tunnel involves cutting the ligament over the tunnel to relieve the pressure on the nerve.

The operation is usually performed under local anaesthetic and takes 20-30 minutes.

At the end of the operation, the hand will be dressed with a supportive dressing that permits finger movement and light hand use.You will be discharged with specific instructions relating to hand exercises and wound care.

Your stitches will be removed two weeks after your operation. Your pain at night should settle immediately but tingling in the fingers may take some weeks to disappear.

You can drive a car after 2 to 4 weeks as long as you are comfortable and have regained full finger movements. Timing of your return to work is variable according to your occupation and you should discuss this.

There are some risks of CTS surgery which you will need to consider before you agree to proceed:

• • Nerve damage: Nerves running in the region can be bruised or damaged during the surgery and form a painful spot in the scar (neuroma) or numbness. The most commonly involved areas are the heel of the hand or the space between the middle and ring fingers. This complication is rare (2%) but may require a further operation to correct.
    
    
  • Recurrence: If you continue to have attacks of tingling and numbness, it might mean that the ligament has been completely cut or has reformed and tightened This is rare (2%) but the operation would need to be repeated to correct this.
    
    
  • Infection: Any operation can be followed by infection and this would be treated with antibiotics.
    
    
  • Scar: You will have a scar on the palm (which sometimes extends a little across the wrist crease). This will be somewhat firm to touch and tender for 6-8 weeks. This can be helped by massaging the area firmly with the moisturizing cream.
    
    
  • Grip: You will find that your grip is weaker than previously and slightly uncomfortable (“pillar pain”). This will gradually improve over six months.
    
    
  • Stiffness: About 5% (1 in 20) of people are sensitive to hand surgery and their hand may become swollen, painful and stiff after any operation (algodystrophy). This problem cannot be predicted but will be watched for afterwards and treated with physiotherapy.
    
    
  • Recovery: Patients who had very numb fingers or wasting of the thumb muscles before surgery will probably never regain full nerve function. Recovery can be very slow (6-12 months). As the nerves grow back, the fingers can actually feel tingly or even unpleasant.