Post Operative Instructions

The operation can be performed under either local or general anaesthetic. Local anaesthetic has been injected around the site of operation and therefore this area and the nearby fingers will remain numb for up to ten hours after surgery. As this effect wears off, it may well be worth taking some pain-killers. Your carpal tunnel pain at night should settle immediately. Any tingling in the fingers may take some weeks to disappear.

Hand elevation is important to prevent swelling and stiffness of the fingers. Please remember not to walk with your hand dangling, or to sit with your hand held in your lap. It is fine, however, to lower your hand for light use and you should get back to normal light activities as soon as possible as guided by common sense. There are a number of exercises you should do to prevent stiffness.

You have been discharged with a supportive dressing, consisting of gauze, wool and a crepe bandage. Please remove the entire dressing after 5 days and inspect the wound. There obviously will be some swelling and bruising. Look out for any redness or tenderness in the area around the wound that might indicate an infection. Do not apply antiseptic but please contact the clinic if you have any worries. It is quite safe to leave the wound open.

At this stage it is safe to get the hand wet in a bath or shower. The wound and the surrounding skin often become very dry and will be more comfortable if a moisturizer is applied. An easy way of doing this is to briefly immerse your hand in some warm water to which some Johnson's baby oil has been added. Alternatively, apply an unscented moisturizing cream such as Diprobase to the skin.

You can drive if you are comfortable and have regained full finger movements and if you have sufficient power to control the vehicle. Timing of your return to work is variable according to your occupation and you should discuss this. 5 -6 six weeks for manual work less for a sedentary job.

Your stitches will be removed at about two weeks after the operation, an appointment will be made for you at the clinic. Following this the scar will be somewhat lumpy, firm and tender. The scar will settle after about three months but this can be helped by massaging the area firmly with the moisturizing cream.

Complications

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 not all the ligament has been cut. This is rare (1%) 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 with either technique which 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 painful, causing discomfort in the heel of the hand. 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.