If you have a nerve conduction study (NCS) or electromyogram (EMG) test that demonstrates moderate or severe carpal tunnel syndrome
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How do I treat carpal tunnel syndrome?
What is carpal tunnel surgery?
What is the recovery time?
How do I book my surgery?
Carpal Tunnel Syndrome
What is carpal tunnel syndrome?
The median nerve of the hand passes under the carpal ligament. This can become impinged when the ligament is too tight - this is referred to as carpal tunnel syndrome.
In simpler terms, this is like a pair of pants that are too tight around your nerve. The tight ligament cuts off the circulation to your nerve and causes your thumb, index, long, and half your ring finger to become numb.
What are the symptoms?
Patients often say their most bothersome symptom is the night time pain. They often wake up with shocks or numbness to their hands and have to shake their hands to “wake it up”
Patients will often say they have numbness throughout the day and may drop objects because they cannot feel it or have developed weakness in their hands.
For mild carpal tunnel syndrome with only occasional symptoms, I often recommend to my patients to use a carpal tunnel splint or get a referral for a steroid injection. The splint prevents the nerve from being kinked since flexing your wrist compresses the nerve. The steroid injection reduces inflammation and makes the carpal tunnel less tight.
For moderate or severe carpal tunnel, I recommend to have a carpal tunnel release surgery.
A small 3-4 cm incision is made and the carpal ligament is then cut open to release the nerve. Dissolvable sutures are used to close the incision. I often do not have any follow-up scheduled with my patients, but if you have any issues please do not hesitate to call my office.
The benefits of the surgery:
The first benefit my patients will notice is that the night time symptoms go away within the first few weeks. This is by far the biggest benefit of doing the surgery and why I would recommend the surgery. If you are not having significant night time symptoms, you may not as much of a benefit
The second benefit is that the numbness in your fingers may improve if they have not been present for years, or may even return to normal. If they have been present for years, the goal is to stop it from worsening
The last benefit I often tell my patients are that the weakness in your hand may improve. This is due to the numbness in your fingers, often forgetting you’re holding an object, and weakness of your hand. This takes a few years to notice improvements. If you have had long standing carpal tunnel, the goal is to stop it from worsening.
What are the risks of surgery?
All surgeries may cause infection, nerve injury, bleeding, or persistent pain
Infection ranges from 1-5%. Patients who have diabetes, use nicotine products, or have an autoimmune disease are at higher risks. If you use nicotine products please stop this 4 weeks before and after your surgery. A mild infection may have some increased pain or redness and can be treated with antibiotics. More severe infections may require the wound to be opened up again and long-term IV antibiotics.
Nerve injury to the nerve is always possible although very rare. To perform a carpal tunnel surgery, we must always see the nerve completely to release the ligament. However, this means that there is always a risk of the nerve being accidentally nicked or cut. If this happens, we will discuss this as this is a very serious complication. This may result in permanent numbness or weakness.
There is no significant bleeding from this procedure, but the wound can ooze blood. If this happens, please place firm pressure on the wound for 10 minutes and this should stop. If it does not, please call our office or present to your nearest emergency department for an assessment.
Persistent pain may continue after surgery either due to scar tissue or sensitive nerves after surgery. This often goes away, but can be quite distressing. I will continue to follow you closely until this improves.
Often times, carpal tunnel syndrome occurs in both your hands. I rarely do surgery on both hands at the same time because you would not be able to take care of yourself with bathing or other daily tasks for 2-4 weeks. I often ask my patients to completely heal from their first carpal tunnel surgery before doing the second surgery. This is often three months after the first surgery.
I ask most patients to take 4-6 weeks to recover before they are back to pre-surgery. Some patients may take longer due to scar tissue pain. I ask patients a minimum of two weeks to let the sutures heal if they cannot take four weeks off work. This is to let the sutures heal the wound. The sutures are strong, but not invincible!
You will be provide with a post-operative instruction sheet to guide you on healing. The dressing can come off after 3-5 days and washed with soap and water. The sutures will start dissolving between 2-4 weeks. After four weeks, if the wound has completely healed there are no restrictions.
I ask all my patients to not place their hands in any still bodies of water until the wound has healed - this includes bathtubs, jacuzzis, beaches, and no dishes for the next month. (I can write a prescription if your spouse does not believe you!) This is to prevent any infections.
A nerve conduction surgery (NCS) or electromyogram (EMG) is required prior to booking you for surgery. Your family physician will often arrange this. Once you have this test completed, please reach out to our office to book your surgery. If your results indicate a moderate or severe, you may schedule a consultation and proceed with surgery in the same visit.. Please ensure you have prepared to have adequate recovery time after the surgery (2-4 weeks off work with the operated hand).