Carpal tunnel compression surgical procedure - Mr Nigel Willis

Introduction

This information, compiled by Nigel Willis, is designed to ensure that you understand what is involved with your upcoming Carpal Tunnel compression surgery and what to expect before, during and after the procedure. Understanding and following these instructions is paramount in order to maximise the benefits of surgery. Mr Willis, physiotherapists and nurses will help further educate you on all matters relating to the procedure. 

There are potential complications that may occur during or after Carpal Tunnel compression surgery, however Mr Willis will inform you about these prior to you agreeing to undergo the procedure. Being an elective procedure means that you can choose not to have it performed if you are not willing to accept the risks involved. Rather than undergoing surgery, you may choose to continue with conservative (non-operative) treatment of your condition.

• What is Carpal Tunnel Compression?

  Carpal Tunnel Syndrome and Carpal Tunnel Compression

  You often hear about Carpal Tunnel Syndrome but less about Carpal Tunnel Compression so we'll clarify this here.

  Carpal Tunnel Syndrome is the actual syndrome the patient suffers and Carpal Tunnel Compression is the surgical procedure used to fix Carpal Tunnel Syndrome.

  Carpal Tunnel Compression surgery

  The carpal tunnel is a narrow space at the front of the wrist through which tendons and nerves pass. These tendons allow the fingers and wrist to bend.

  When the tendon swells, sometimes due to overuse, there is very little space in the tunnel for them to expand, and in some people this expansion causes carpal tunnel syndrome, when the tendons compress the median nerve, which runs near the tendons. The compression causes numbness and tingling and affects nerve impulses, so it may be difficult to grip objects, such as cutlery or pens.

  This procedure is intended to relieve the symptoms of altered sensation, pain and weakness of the hand.

  Are there any alternative treatments?

  If your symptoms are mild you can try wearing a wrist splint. Another thing to try is having a steroid injection into the wrist.

  Some surgeons do keyhole surgery instead of open surgery. However there is no evidence that the results are any better. The complications are greater than with open surgery.

   

• What happens prior to surgery?

  Prior to admission you may need to have a pre-operative assessment. This is an assessment of your health to make sure you are fully prepared for your admission, treatment and discharge. The pre-operative assessment nurses will help you with any worries or concerns that you have and will give you advice on any preparation needed for your surgery.

  Before the date of your admission, carefully read the instructions given to you. If you are undergoing a general anaesthetic you will be given specific instructions about when to stop eating and drinking, please follow these carefully as otherwise this may pose an anaesthetic risk and we may have to cancel your surgery.

  Nigel Willis and the anaesthetist will answer any questions that you have. You will be asked to sign a consent form. A nurse will go with you to the anaesthetic room and stay with you. A cuff will be put on your arm, some leads placed on your chest, and a clip attached to your finger. This will allow the anaesthetist to check your heart rate, blood pressure and oxygen levels during the operation.

• The surgical procedure

  An operation on the carpal tunnel is relatively straightforward and requires only a local anaesthetic, which means that the area being operated on is numbed and you will be awake throughout the operation. In most cases, patients are in hospital for half a day, but this will depend on each patient’s specific needs.

  The affected arm will have an antiseptic solution applied to it and will then be wrapped with a tight or elasticated bandage. This squeezes the blood out of the arm, so that the affected area is free of it.

  A small cut is then made in the crease of the wrist, the skin is held back by small retractors to expose the carpal tunnel roof, called the fascia. A small incision is made in the fascia to separate the edges, which will be held back by nylon stitches. The hand is then bandaged, although the fingers and thumb are left free to move.

  A new fascia will grow over the following few weeks, enlarging the carpal tunnel area, relieving the symptoms.

• Risks & complications of the procedure

  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. The most common complications are wound infection (treated with antibiotics) and haematoma (blood clot). 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.

  Please be sure to ask any questions you may have during your pre-operative assessment appointment or when you see your consultant before your operation. It is important you know about, and accept, any possible risks before you sign your consent form.

• What happens after surgery?

  You will return to the ward with a large dressing over your hand and possibly a sling. You must remember to keep your arm elevated for the first 48 hours and to move your fingers to prevent stiffness. You will be given specific instructions about the removal of the dressing. A nurse at your GP’s surgery will remove your stitches or you can return to the ward 7-10 days after surgery.

  You will be given more detailed instructions about incision care before your surgery.

Please note that this orthopaedic surgery procedure is elective (you can choose to have this surgery or not). The decision to choose surgery is made at the end of a thorough consultative process between you, your othopaedic surgeon and where required, other medical specialists.

It is very rare where two people have exactly the same issue, so each procedure and post-surgery treatment is specifically diagnosed and tailored to your individual requirements.

Therefore, the information provided here is for general advice only and is not a substitute for a consultation appointment with your orthopaedic surgeon.

For consultations with Mr Nigel Willis, please ask your GP for a referral.