CARPAL TUNNEL SURGERY
This is the most common hand operation that is performed. Carpal tunnel syndrome is a condition where the nerve (median nerve) that runs through the palm of the hand goes through a tunnel which is called the carpal (meaning wrist) tunnel. If the nerve gets compressed on its way through the tunnel then it causes symptoms and this is called carpal tunnel syndrome.
Symptoms include –
1 Numbness in the thumb, index finger, middle finger and half the ring finger
2 Pain in the hand
3 Pain in the forearm
4 Weakness of the hand
It typically gets worse at night when the swelling increases in the tunnel and can be exacerbated by certain positions of the hand eg. Talking on the phone or driving.
The diagnosis is a clinical one however most patients will also require a nerve test to confirm the diagnosis before proceeding to surgery. This is called a nerve conduction study and electromyogram or more simply known as NCS/EMG. It is very helpful if your GP can arrange this prior to your appointment as surgery can then be booked straight away.
The most usual operation performed is an open carpal tunnel release. This is an incision in the palm which is about 4 cm long and the tunnel is released. It is a very successful operation with a greater than 95% success rate and is done as a day case. In severe case it can take a long time for the nerve to recover and the symptoms to improve.
In specific instances an endoscopic approach may be considered.
PREPARATION FOR SURGERY
General Pre-operative Instructions
Smoking increases the risks of many complications of surgery significantly and should be ceased 6-8 weeks prior to surgery. This is mandatory for all non-urgent procedures. (See Smoking and surgery)
There are medications available over the counter which can cause your blood to thin and cause bleeding – some of these may seem innocuous and be sold as herbal remedies. These should all be stopped prior to any surgery. Any medication containing aspirin or anti-inflammatory medications should be ceased 1 week prior to surgery. These include Aspirin, Dispirin, Aspro, Aspalgin, Cartia, Astrix, Brufen, Voltaren, Nurofen, Toradol, Naprosyn, Indocid.
Plavix, etc should be ceased 2 weeks prior to major surgery
Warfarin, Xarelto, Pradaxa need to be ceased 3 days prior to surgery.
Please note this list contains most of the common blood thinners but is not exhaustive.
For minor procedures such as small hand procedures or simple skin cancer excisions it may be OK to continue on your blood thinning medications so please consult your surgeon who will guide you.
Cease ALL herbal and non-prescription medications before any surgery- major or minor. The most common herbs used are Garlic, Ginseng, Ginkogo, Echinacea, Ephedra, Kava and Valerian. They may cause interactions with anaesthetic drugs, cause bleeding and reduce wound healing after surgery. Please note this list is most of the common herbal remedies but it is not exhaustive.
Panadol, Mobic and Celebrex are OK to continue.
The following is general advice only and should not be substituted for specific advice from your physician, anaesthetist or surgeon.
Non-insulin diabetics should withhold their last dose of medication prior to surgery.
Insulin dependent diabetics should take half of their last normal insulin dose prior to surgery. Where possible you will be placed early in the operating list sequence.
All other medications should be continued unless otherwise instructed.
Please consult your physician before ceasing any medication.
You are encouraged to shower or bath in the usual fashion both the night before surgery and the morning of surgery paying particular attention to the area to be operated on. This decreases the bacterial number and should prevent infection. You should wash in the normal manner with soap and water and do not scrub the area with a scrubbing brush.
Remove all jewellery.
Clothing and footwear should be loose and comfortable.
You should have nothing to eat or drink for 6 hours before your operation. This includes chewing gum.
It is ok to take regular medications that need to be continued with a sip of water.
HAND POSTOPERATIVE INSTRUCTIONS
The usual dressing will be a gel gauze on the wound covered with gauze and a bandage. This may be supplemented with a half plaster splint for certain procedures. You should keep this clean and dry for the first week.
Most of the sutures are dissolvable and under the skin and can’t be seen. They don’t need removal. There may be some sutures which need to be removed which is usually at day 14.
Major operations by their nature will have some degree of pain involved. Your surgeon will let you know the specifics of your procedure. The pain is generally not as bad as expected. Pain relief is very important and we take it seriously. Often you will need 1 or 2 doses of stronger medication through the drip for the first night and after this, the rest of your pain relief can be taken in tablet form. This will be discussed with you by the anaesthetist before the operation.
You will be encouraged to mobilise on the first post-operative day and your mobility will progressively increase over the next few days. This is critical as the most important thing you can do to prevent DVT (deep vein thrombosis) is to walk. It also speeds your recovery and decreases the chances of other complications. Your inpatient stay will depend on the procedure but many operations can be performed as day cases or overnight stays. Light activity such as a fast walk that raises a sweat is comfortable at 4 weeks. Sporting activities and heavy lifting should be avoided for about 6 weeks.
TIME OFF WORK
For minor procedures done in our rooms you literally only need the time off for the procedure itself which is usually about 30 minutes. Similarly, most day case operations only require one day off work.
For major procedures, the usual timeframe is 1-2 weeks however this depends on the actual procedure and the nature of your employment. Please ask your surgeon for a more accurate guide
You will be permitted to drive 1-3 weeks after your procedure depending on the type of surgery.
It is not uncommon for the skin around the scar and the area that has been operated on to be numb after the operation. This is normal and does not mean that a major nerve has been cut. It occurs because when an incision is made or skin has been removed then there is damage to microscopic nerves which can’t be seen. If you feel tingling, burning, or shooting pains this is not causing for alarm and in fact is an indication that the small sensory nerves are regenerating. This feeling will disappear with time and the sensation will return but it can take a long time.
Horizon Plastic Surgery advises scar management to start 2-3 weeks after your surgery or when the wounds are healed. You can either tape the wounds with micropore which will provide support to the wound and then moisturise and massage each time the tape is removed. This tape can stay on for 2-3 days each time. If you are finding that your skin is becoming irritated then please discontinue use and contact our nursing staff who will advise you of a course of action. For high-risk patients you may be prescribed a silicone gel tape called sicacare which can aid in reducing scar formation and can be bought buy from the chemist. Scar management should be continued until 3 months post surgery.
You will usually be required to wear TED stockings for compression to prevent DVT (blood clotting in the legs) post-operatively. If required these will be fitted at the hospital on your admission day. They are generally only worn whilst you are in hospital.
You will be discharged with both pain relief and antibiotic medications. Please take as directed. Most medications you ceased prior to surgery can be recommenced 1 week after your surgery but this will be individualised to each patient so please ask your surgeon.