Carpal Tunnel Decompression

Incision of the ligament overlying the nerve

Procedure

Decompression of the ‘Median nerve’ at the level of the wrist. This is usually done under local anaesthetics through a small incision just below the wrist (see arrow above). Some surgeons perform this endoscopically. This is done with the aid of a small camera (like an endoscopic gall bladder operation). There is not evidence that this will lead to a better outcome.

Indication

Carpal Tunnel Syndrome

Risks

Acute: Bleeding, Infection, neurological deficit including numbness of the thumb, index and middle finger and weakness of the thumb. No improvement of symptoms in particular in cases where there is established nerve damage. Risks are small and the overall chance of long term improvement is very good.

Hospital stay

Usually day case surgery

Anaesthesia

Usually under local anaesthesia, general anaesthesia in exceptional cases (previous Operation)

The scar is barely visible after it is fully healed

Recovery

A bandage is applied for 48hours after the operation. The dressing underneath should not get wet for 2 weeks when the sutures will be removed. It is important to keep the hand elevated for a few days after the operation and keep the fingers moving. If this is too painful in the first few days, patients should move them passively with the other hand on a regular basis. Carrying anything heavy should also be avoided for the first few weeks. This means that although it is only a small operation, patients should make arrangements to have support as it can be awkward if the dominant hand is affected.

Commonly asked questions

When should I have the operation?

In mild to moderate cases conservative treatment (splint, injection) should be tried first. In cases where this has not improved symptoms or in severe compression resulting in numbness and or weakness surgery should be considered.

What should I do if both hands are affected?

Surgery should not be performed on both sides at the same time, as this will cause significant problems in day-to-day life. The more symptomatic hand should be done first and once it has recovered, surgery can be done on the other side. It is possible to do an injection on one side at the same time with an operation on the other side.