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Treatment Operative
The surgery for carpal tunnel syndrome
consists of taking pressure off the median nerve
by dividing the carpal ligament. If surgery is not
performed the pressure on the median nerve will
continue and slowly even over years, cause more
numbness to your thumb, index finger, middle
finger and part of the ring finger. Eventually,
the muscle that allows you to lift your thumb
away from your hand will become weaker.
These more severe changes will take many
months and probably years to develop.
Therefore there is no urgency to have surgery
for carpal tunnel syndrome unless you have had
a trauma to your arm with a sudden onset of
symptoms.
The operation to release the carpal
tunnel and to decompress the median nerve
involves an incision in the palm and it is usually
2
Postoperative Management motion of your wrist and hand, you will likely
Your hand and wrist will be placed in a be more comfortable and get a better nights
bulky dressing that goes from your hand to your sleep wearing the wrist splint at night (about 2-4
forearm, leaving your thumb, fingers and elbow weeks).
free to move. Bending and straightening your In the majority of cases, patients can do
fingers will help to keep the soft tissues gliding the range of motion and strengthening exercises
smoothly, to decrease the swelling and to keep on their own. Patients, who are returning to
your joints from becoming stiff. If you are work that requires a lot of strength or who are
given a sling, you should only use it for comfort progressing slowly with their movement, may be
for the first 24 hours or you may get more sent for therapy. This will help to regain your
stiffness to your elbow and shoulder. At your range of motion and strength more quickly. It is
first postoperative visit, 2 to 3 days following anticipated that the majority of patients will
surgery, the bulky dressing will be removed and regain full function of their hand within a couple
you will be instructed in range of motion of months, although the incision may remain
exercises for your hand, wrist, elbow and tender for many months while the scar tissue at
shoulder. You may now shower and wash your the incision matures.
hands with soap and water (however, do not Return of sensation to the hand will vary
soak your hand in water until the stitches have in the time it takes to come back. Some or all of
been taken out). A light dressing will be placed the tingling will likely be relieved fairly soon
over the stitches and you will be given a wrist after the surgery. If however, you have had
splint to wear at night. During the day, we symptoms for a very long time and had severe
encourage you to regain your active range of numbness to your fingers and weakness to your
motion and to use your hand for light activities, thumb muscles, these improvements will take a
avoiding activities that require strength of your much longer period of time, at least 1 year. The
operated hand. The stitches will be removed nerve will regenerate at the rate of 1 inch per
about 2 weeks after surgery. Gentle massage of month. As the feeling comes back, you may
the incision region with cream will help to notice more pins and needles, burning or
soften this area. In some patients however, this crawling feelings to your hand and this is normal
area may remain swollen and hard for many sensory nerve regeneration.
months. Until you have regained full range of
Written by:
Susan E. Mackinnon, MD & Christine B. Novak, PT, MS
Washington University School of Medicine, St. Louis, Missouri
March, 2001