Carpal tunnel syndrome is caused by compression on the median nerve. The median nerve passes through the carpal tunnel in the wrist. The carpal tunnel is formed by bones of the wrist and a band of tissue called a ligament.
We attempt non operative management first with activity modification, cortisone injections and night time splinting. When this fails, we consider an operation to release the carpal tunnel.
A Carpal Tunnel Release involves releasing the ligament that forms the tunnel. This can be done with an open incision over the carpal tunnel or via keyhole/endoscopic surgery. The aim of this surgery is to allow more space for the nerve so that the symptoms reduce.
The area where the surgery occurs is usually tender for at least four to six weeks after the surgery. It may be several weeks or longer before you can return to your usual level of physical activity.
How long will my hand be swollen for?
Swelling may last up to 3 months, but this will improve on a daily basis. Keep your hand elevated immediately after surgery.
How long will my hand be tender for?
Pain after a carpal tunnel release is generally for 4 to 6 weeks but the pain should subside rapidly. Sometimes the pain may linger for a longer duration but the expectation is for your pain to resolve.
Will I need to keep my hand dry?
Yes. Keep the crepe bandaging intact and dry for the first 48 hours. You may debulk the wrapped dressings (crepe and velband) but please leave the sticky dressing intact until your review at 2 weeks post operatively. You may wash your hands if the opsite sticky dressing remains intact and watertight.
Can I use my hand post operatively?
You can perform light duties. As your hand will be swollen and sore for 4 to 6 weeks, you’ll be limited to light activities such as dressing, self care, brushing your teeth and carrying no more than a cup of tea. After your day 10-14 review with the doctor, we will allow you to start washing your hands. The sutures are absorbable (vicryl rapide) and will fall out as they dissolve.
Carpal Tunnel Release Protocol
Weeks 0-2
Patient may remove the bulky bandaging after 48 hours post surgery.
Commence finger and gentle wrist range of motion exercises.
Waterproof dressing to remain on until the next review at 2 weeks post operatively. If the dressing seal is broken, this will need to be changed. Don’t get your hand wet if the dressing seal has broken as this may cause wound complications and an infection.
Strictly no heavy lifting in this period.
Day 10-14 follow up
Dr Jang will assess your wound. Generally, we use absorbable sutures which fall out after you commence hand washing.
Weeks 2-6
It is ideal to see a hand therapist to assist with your recovery after carpal tunnel surgery.
- Scar management
- Desensitisation exercises
- Nerve gliding program
- Begin wrist flexion and extension.
- Begin grip and pinch strengthening exercises (theraputty)
Tendon Gliding Exercises
Perform this sequence of fists 10 repetitions, 5 times per day
Now that your incision is healed and we can be more vigorous with your wrist motion, it is important to glide the median nerve along its path to avoid it also being surrounded by scar tissue. That is done by performing this series of motions:
Repeat this sequence 5 repetitions, 5 times per day – Hold each position 10 seconds
Post operative instructions
Scar Care
- Massage your scar with lotion for 5 minutes 5 times per day. Use a moderately deep pressure to help flatten the scar and decrease its sensitivity to pressure.
- Wear the silicone scar pad to sleep to help soften the scar while you sleep. Make sure your skin is clean and dry before applying the scar pad each night. You can wash it each morning with soap and water, and dry it with a CLOTH towel.
Splint
- Wear your splint at night until 6 weeks post operatively as needed for support.
Returning to Activities
- Most patients can resume full use of their hand after surgery by about 6 weeks post operatively, but please let your comfort be your guide. Do not repetitively perform activities that cause you pain. A gradual return to activities without pain is our goal.
- If you do not feel that your strength is returning by the 6th week, please contact your therapist as you might need one more session to add hand strengthening to your home exercises.