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Carpal Tunnel Decompression

What is it?

A nerve to your finger ends runs deep inside the front of your wrist (carpus). It runs inside a little tunnel (the carpal tunnel). There is not enough room for the nerve as it runs through the carpal tunnel. It causes pain and tingling in the fingers and hand, and even higher up the forearm.

The Operation

A cut is made in your palm, next to the skin crease that runs up the centre. The roof of the tunnel is then cut to give your nerve more space. The wound is then closed up with stitches or clips. You can be given a local or a general anaesthetic. The choice depends partly on which you prefer, and partly on the anaesthetist and surgeon. Having general anaesthetic means that you will be completely asleep during the operation. Having a local anaesthetic means that you will be awake during the operation, but will not be feel any pain in your hand since the area of the operation is numbed with a local injection. After an hour or two on the ward following the operation, you should feel fit enough to go home.

Any Alternatives

If your symptoms are mild you can try wearing a wrist splint or having a steroid injection into the wrist. If your symptoms really bother you, the best plan is to have the operation.

Before the operation

Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check that you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to the hospital. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. . Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After - In Hospital

Usually the wound is pain-free. You may feel some discomfort. You will be given painkillers to take home. They should easily control this discomfort. If you have had a general anaesthetic it will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions, drive a car, use machinery, or even boil a kettle during that time. Your hand will be in a bulky bandage when you go home. Your arm will be in a sling to reduce any swelling. Wear your sling for the first 24 hours or so after your operation. Your bandage will be taken off and your stitches will be taken out about 10-12 days after the operation. You will not need a dressing on the wound after that. You may remove the sling to wash. Wash around the bandage for the first 10 days. You can wash the wound area as soon as the dressing has been removed. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or take a bath as often as you like once the wound has healed. Some hospitals arrange a check-up about one month after you leave the hospital. Others leave check-ups to the General Practitioner. The nurses will advise about sick notes, certificates etc.

After - At Home

Make sure a relative or friend can take you home. You should not be by yourself for the first day after your operation. At home, rest. Take some painkillers to control any pain. The second day after the operation, you should be reasonably comfortable. You must move your fingers for five minutes every hour to exercise them. You cannot drive whilst your hand is in the bandage. How soon you can return to work depends on your job. If you can work one handed, you may be able to return to work two or three days after your operation. This also depends on you being able to get to work. If your job is manual you will be unable to work for six weeks. You should be able to swim once your stitches are out. Your nerve pain and the pins and needles at night should go immediately after your operation. If your fingers were partly numb before the operation, they may take months to feel normal.

Possible Complications

If you have the operation under general anaesthetic there is a very small risk of complications related to your heart or your lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

Complications are rare and seldom serious. Rarely, you can develop an infection in the area of the operation which can be settled by taking antibiotics for a few days. Also rarely, a nerve or a blood vessel can be damaged during the operation and you might need another operation to fix the problem.

Finally, very rarely after this operation, the hand can become very stiff, painful and swollen and requires intensive long-term physiotherapy to get better.

Your hand should not hurt much after your operation. If you have severe pain, telephone the ward. If you cannot get through to the ward, come straight away to the casualty department of the hospital. Sometimes the operation is not as successful as expected, especially if the pains had been there for years, or if there are other causes for these pains.

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