Hand

Post-operative instructions following Carpal Tunnel Release

First 48 hours

  • Keep the hand elevated
  • Move the fingers and thumb, elbow and shoulder as much as possible
  • The local anaesthetic will wear off a few hours after the operation and you may experience some discomfort. Take simple painkillers such as paracetamol if required.
  • Use the hand for simple every day activities.

48 hours post-operation

  • Unwrap the crepe and wool bandages.
  • The dressing stuck to the skin can be replaced. Suitable dressings will be supplied by the hospital
  • Continue to keep the hand dry
  • Keep the fingers moving and use the hand as symptoms allow
  • You can start driving as soon as you feel safe and comfortable to do so.

12 to 14 days post-operation

  • The sutures used to close the wound will need to be removed. This will either be by the nurse at your GP surgery or at the hospital.
  • Once the sutures have been removed you can wash the hand normally
  • Start massage the scar with a moisturising cream such as E45 3 times a day.

Potential complications and expected recovery

  • Use of the hand steadily increases. Most people are back doing all their normal activities by 6 weeks after the operation
  • If there was constant numbness of your fingers before the operation then the sensation can take several months to recover, and recovery cannot be guaranteed.
  • There is a small risk of a wound infection. If this occurs there will be swelling, redness and possibly discharge from the wound. If this occurs it will usually settle with a course of antibiotics.
  • The scar can be tender. Massaging it once the sutures have been removed helps with this.
  • There is a small risk of damage to small nerve branches, which can leave a numb patch of skin in the palm or very rarely weakness of the muscles which move the thumb.
  • Any intermittent carpal tunnel symptoms usually resolve very quickly after the operation, but as for any operation there is not a 100% success rate.
  • Some patients will develop a condition called complex regional pain syndrome after their carpal tunnel release. The severity of symptoms and how long they last is variable, but can affect about 1 in 20. When severe the hand is painful, stiff, hypersensitive, and may be swollen, sweaty, hot and blotchy.

What does the procedure involve? A tourniquet will be inflated to improve visualisation. Two small (1cm) incisions will then be made on either side of the kneecap, one for the camera and one for any surgical instruments. Sometimes extra incisions are needed above the kneecap, particularly in more complicated cases (Ligament reconstruction). A full keyhole (arthroscopic) assessment of your knee joint will then be carried out to confirm the damage and evaluate the knee fully. Pictures of the knee are taken  and we can go through these at the follow-up clinic appointment.

What are the chances of an improvement in my symptoms: Knee arthroscopy is a safe and effective operation for improving mechanical symptoms (catching, clicking, locking and giving way) and pain associated with damage to the knee soft tissues. When your knee has painful arthritis (complete loss of cartilage with underlying bone pain) then arthroscopy will not be successful as further trimming of the soft tissues can make the situation worse.

What can I expect after surgery? – Once the local anaesthetic has worn off you will need tablet painkillers for a period of time; this can range from a few days to a few weeks depending on the complexity of your surgery. You will be encouraged to mobilise early with the onsite specialist physiotherapy team and typically discharged home on the day of surgery. For more complex cases, such as ligament reconstructions or meniscal repair, you will need to take blood thinning tablets (Aspirin commonly) or a daily injection for up to 6 weeks after surgery whilst less mobile and on crutches. Ongoing physiotherapy after surgery is essential in order to restore a good range of motion and ultimately to help you build muscle bulk for strength and control.

Driving: You can drive once you are no longer reliant on crutches. For most arthroscopic procedures this  is usually 1-2 weeks. For more complex reconstructions then up to 8 weeks is typical.

Returning to Work

Simple knee arthroscopic procedures – Desk-based duties: Usually 1 week. When a long or difficult commute is required, or in cases of return to more manual work 2 or 3 weeks may be necessary. Complex knee reconstructions & repairs: up to 8-12 weeks depending on your job complexity. Often a period of amended duties will be necessary for heavy manual work.

Returning to Sporting activities

  • Simple knee arthroscopic procedures: 3-4 weeks
  • Complex knee reconstructions & repairs: 9-12 months

What are the potential complications or risks associated with this surgery?

Bleeding/bruising: Bleeding is typically minimal and occurs in the first couple of days after the surgery. This may necessitate a change of dressings if they come loose. Bruising can be significant, particularly after more complex surgery, and will often track down the leg to the ankle and foot but will settle and does not cause long term problems. Elevating the operated leg when resting (including at night) on a pillow will help to minimise swelling in the first few weeks after surgery. Regular icing should also be used liberally – this improves swelling and pain after surgery. An ice pack for 10 minutes in every hour can be used.

Infection: This is a rare complication and occurs in less than 1% of cases. It is a potentially serious complication when it does happen, however. Usually the infection is superficial involving the skin and will settle with antibiotics but if it is a deeper infection, this will require further surgery to wash out the wound.

Nerve and vascular injury: Damage to the major nerves and blood vessels at the back of the leg are, thankfully, very rare after keyhole surgery (less than 0.1%). The small superficial nerves that supply the area of skin on the front of the leg, known as cutaneous sensory nerves, are commonly in the operative incision line and damage is unavoidable. This results in a numb patch near the scars which may track down the lower leg towards the ankle. The usual course is that the affected numb area will reduce in size during the first year after surgery but may never go away completely.

Blood clots in legs or lungs: We worry about leg vein clots (Deep Vein Thrombosis or DVT) because clots can be dislodged and travel to the lung where they can become a life-threatening problem (1:10,000). For this reason you will be given blood thinning injections until fully mobile and weight bearing normally. For less complicated cases you will be able to fully weightbear straight away and these measures will not usually be required. For complex cases blood thinning injections or Aspirin may be necessary for up to 6 weeks following surgery.

Anaesthetic risks: Modern anaesthesia is usually very safe, but there are small risks associated with general anaesthetics including airway problems and unexpected allergic reactions. There are separate risks associated with receiving a nerve block. The anaesthetist will be able to go through these risks with you prior to the operation. 

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