Physical Examination and Procedure

During your evaluation, Dr Brosnan and Dr Carter will talk to you about your general health and medical history and ask about your symptoms. They will carefully examine your hand and wrist and perform several physical tests:

Press down or tap along the median nerve inside your wrist to see if it causes any numbness or tingling in your fingers.
Bend and hold your wrists in a flexed position to test for numbness or tingling in your hands.
Test sensitivity in your fingertips and hands by lightly touching them with a particular instrument when your eyes are closed.
Check for weakness in the muscles around the base of your thumb.
Look for atrophy (wasting) in the muscles around the base of your thumb. In severe cases, these muscles may become visibly smaller.

The surgical procedure performed for carpal tunnel syndrome is called a "carpal tunnel release." The operation can usually be performed under a local anaesthetic and takes about 20 minutes. There are multiple different surgical techniques for doing this, all aim to relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel. This increases the tunnel's size and decreases pressure on the median nerve.

The carpel tunnel surgery can be done under general anaesthesia, which puts you to sleep, or under local anaesthesia, which numbs just your hand and wrist. In some cases, you will also be given a light sedative through an intravenous (IV) line inserted into a vein in your arm.

Dr Brosnan will make a small incision in the palm of your hand and view the inside of your hand and wrist through this incision. During the procedure, he will cut the tight ligament (the flexor retinaculum) that forms the roof of the carpal tunnel. This stops the nerve from being compressed. After surgery, the ligament may gradually grow back together—but there will be more space in the carpal tunnel and pressure on the median nerve will be relieved.

Recovery and Post-Operative Care

Immediately following surgery, you will be encouraged to elevate your wrist above your elbow and move your fingers to reduce swelling and prevent stiffness however, some may get relief from symptoms the same day as your surgery. You should expect some pain, swelling, and stiffness after your procedure.

You may have some soreness for anywhere from a few weeks to a few months after surgery. It's usually controlled with pain medicines taken by mouth, and Dr Brosnan will let you know any medications you may have to take. The surgeon may also have you keep the affected wrist elevated while sleeping at night to help decrease swelling. Your bandage will stay on for 5 days. You will, however, be allowed to use your hand for light activities whilst taking care to avoid significant discomfort.

Dr Brosnan will give you exercises to do during this time to move your fingers and keep them from getting too stiff. You can use your hand lightly in the first 2 weeks, but it helps to avoid too much strain. Grip and pinch strength usually return by about 2 to 3 months after surgery. If the condition of your median nerve was poor before surgery, however, grip and pinch strength may not improve for about 6 to 12 months.

Slowly, you can get back to more normal activities, like:

Driving (2 weeks after surgery)
Writing (approximately a week post-surgery)
Pulling, gripping, and pinching (6-8 weeks out, but only lightly. Expect 10-12 weeks before your full strength returns, or up to a year in more severe cases.)
Dr Brosnan will talk to you about when you can go back to work and whether you'll be limited in what you can do.

Dr Brosnan may suggest you practice specific post-operative procedures for better recovery and to avoid further complications:

Elevate the wrist above elbow to reduce swelling.
You may wear a splint.
Ice packs to the surgical area to reduce swelling.
Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
Physiotherapy may be ordered to restore wrist strength.
Eating a healthy diet and not smoking will promote healing.