Carpal Tunnel Surgery FAQ
What are the non-surgical options for carpal tunnel syndrome?
- Wrist splints are the commonest non-surgical treatment. The splint is worn at night only, holding the wrist in a straight position. Normally, the wrists bend during sleep (which increases the pressure on the nerve). They can be very effective in milder cases, especially for relief of nocturnal symptoms. I do not advise wearing them throughout the day.
- Medical treatment of underlying causes or rrisk factors of carpal tunnel syndrome e.g. hypothyroidism, rheumatoid arthritis, diabetes.
- Steroid injection, performed under ultrasound-guidance. This is best when there are underlying conditions causing inflammation within the carpal tunnel e.g. tenosynovitis. It is also useful as a temporary measure for women during pregnancy. In other situations, the long-term cure rates are low.
Is there any scientific evidence that chiropractic/homeopathy/vitamins can give permanent cure?
No. I'm sorry to be blunt, but you're wasting your time and money with alternative treatments.
When should I consider carpal tunnel release surgery?
- When non-surgical options have failed, and you find the symptoms troubling. Mild symptoms (especially with a short history) do not necessarily need surgery. But please note that some people, especially the elderly, have little pain, but do develop a slowly progressive numbness.
- When you are at risk of permanent nerve damage (see below).
What are the results of surgery?
Carpal tunnel release is one of the most successful hand surgical procedures. Pain and tingling should rapidly vanish, sometimes by the next day. Numbness may take much longer to improve, but usually does eventually resolve. Normal hand function is the expected outcome. We commonly hear "I wish I had done this years ago".
Nevertheless, there can be problems. Read on for the bad news.
What are reasons for poor results?
- Irreversible nerve damage that occurred before the surgery. This is the commonest reason for persisting symptoms. Warning signs of this are:
- Severe changes on the nerve conduction studies
- Constant and long-standing severe symptoms, especially numbness, before surgery
- Muscle wasting (atrophy)and weakness
- Inadequate surgical release of the transverse carpal ligament, so that the median nerve remains compressed. This should be very rare if an expert hand surgeon does the surgery.
- A second site of compression i.e. nerves are compressed at another site, as well as at the carpal tunnel. The usual second site is in the neck/cervical spine. This is not rare, and will require further investigation and treatment by another specialist.
- Diabetic neuropathy. Unfortunately some diabetics can have both carpal tunnel syndrome and neuropathy. Surgery will usually offer at least some benefit, and is worth performing (in consultation with your endocrine doctor).
- Wrong diagnosis.
Severe carpal tunnel causing wasting of the small muscles and inability to lift the right thumb
What are the complications of CTS?
- Infection, bleeding, delayed healing
- Tenderness or numbness around the scar
- Weak grip
- Joint stiffness
- Pillar pain
- Injury to adjacent structures
- Persisting symptoms
- See also general complications of hand surgery
Bilateral release?
Many people have symptoms in both hands. You can chose to have them released one at a time (with a few months interval), or both at the same procedure.
I recommend simultaneous release for most patients. This has the advantage of less total time off work, less hospital time and fewer post-op visits. You can expect earlier relief of symptoms - if you're losing sleep due to pain and tingling, this will obviously continue in the un-operated hand, and you may not feel much better off until you return for the second side.
Patients who may prefer staged surgery include:
- the elderly
- those without social support or who live alone
- anyone relying on walking aids
- those at risk of chronic pain syndromes
- when the diagnosis or results are particularly uncertain
- if you are very nervous about surgery
Endoscopic vs Open surgery?
The long term results are identical. Endoscopic carpal tunnel decompression can give a quicker recovery and return to work, especially in manual workers. Some doctors believe that the risk of major nerve injury is slightly higher with keyhole release. I have been trained in endoscopic release, but no longer perform this.
What happens during surgery?
Most surgery is performed under "twilight anesthesia". The anaesthetist will send you to a very happy place, without the risks of full anaesthetic. Local anaesthetic is injected around the carpal tunnel (this stings but you won't remember this part). You may vaguely feel a tourniquet cuff squeezing your upper arm for 10-15 minutes.
This YouTube video demonstrates an incision and surgical technique very similar to mine.
Is carpal tunnel surgery painful?
No, not usually.
Long-acting anaesthetic is used, which should make the entire area numb until the next day. This often affects the fingers as well, so don't be alarmed if your fingers have still lost feeling post-op.
Simple painkillers such as paracetamol should be sufficient the following day. And don't overdo things! Significant pain is a sign of problems - please give us a call.
What to expect after carpal tunnel surgery?
The hand should remain bandaged for 1-2 weeks, and must be kept dry. There may be mild swelling and bruising in the fingers and forearm. The fingers will be free, and you are encouraged to perform very light activities. A follow-up appointment with me will be arranged at around 10 days. If there is any stiffness I will arrange hand therapy and exercises at the same visit.
Can I drive?
The safe answer is: not for 2 weeks. The risks are to yourself (being forced to suddenly grip the wheel, causing problems with the wound), and to others (not having full control of the car).
The legal and insurance aspects of driving with your hand in a bandage are not clear.
What about time off work?
This depends very much on the nature of your job.
Office workers, presuming they don't need to drive, could return within a couple of days if motivated. You will not be able to do any sort of lifting or gripping, but could manage typing and light paperwork.
Most workers are fairly comfortable at the two to three work stage.
Heavy workers (construction, mechanics etc) may need up to 6 weeks, and even then may experience some discomfort on gripping and tool use. Full strength may take a few months to return.
Does carpal tunnel syndrome recur?
Despite what you may have heard, this is rare.
What is the cost in Australia?
This question is not as easy to answer as it appears to be; the private medical insurance system in Australia is ridiculously and needlessly complicated. The MBS rebate for the surgical fee is roughly $220-290. There will be a known gap for surgeon and anaesthetic fees. Most patients also have an excess for hospital fees. Here is an online calculator; your insurance fund may offer something similar.
My staff will help you with a written quote before surgery, which is usually accurate. I do not have patients complaining about "unpleasant surprises".
External Resources
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/carpal-tunnel-release
https://www.ncbi.nlm.nih.gov/books/NBK279597/
https://www.rcseng.ac.uk/patient-care/recovering-from-surgery/carpal-tunnel-release/