What is carpal tunnel syndrome?
Carpal tunnel syndrome refers to pain, tingling, or numbness in one or both hands resulting from compression of the median nerve at the wrist. These symptoms are frequently worse at night, and often improve by shaking of the hand.
This problem is diagnosed by a combination of clinical assessment and nerve conduction studies.
In some cases, such as during pregnancy, carpal tunnel syndrome may resolve on its own. However in many patients, the problem requires surgery.
How is it treated?
Carpal tunnel syndrome frequently responds to analgesia, the use of a hand splint at night, and the avoidance of aggravating activities, such as the operation of vibrating objects (eg jackhammers).
In cases which do not respond to conservative measures, surgery may be indicated. This operation is performed frequently by neurosurgeons, and is known as a carpal tunnel decompression. It involves making a small incision, or cut, in the palm of the hand, and dividing the band of tissue which is constricting the nerve. This is done usually under local anaesthetic and light sedation and the patient returns home on the same day.
Who will perform surgery? Who else will be involved?
Surgery will be carried out by your Precision Neurosurgery surgeon. A surgical assistant will be present and an experienced anaesthetist will be responsible for your anaesthetic. Carpal tunnel decompression is usually performed under local anaesthesia and sedation.
What are the aims and potential benefits of surgery?
The goals and potential benefits of surgery include:
- Relief of neural compression
- Pain reduction
- Prevention of further deterioration
The chance of obtaining a significant benefit from surgery depends upon a wide variety of factors. Your neurosurgeon will give you an indication of the likelihood of success in your specific case.
What are the possible outcomes if treatment is not undertaken?
The natural history (ie the outcome if carpal tunnel syndrome is left untreated) is difficult to predict. Potential outcomes of not treating your condition include:
- Ongoing pain
- Impaired hand function
What do you need to tell your doctor before surgery?
It is important that you tell your surgeon if you:
- Have blood clotting or bleeding problems
- Have ever had blood clots in your legs (DVT or deep venous thrombosis) or lungs (pulmonary emboli)
- Are taking aspirin, warfarin, or anything else (even some herbal supplements) that might thin your blood
- Have high blood pressure
- Have any allergies
- Have any other health problems
How is the surgery performed?
Before surgery you will have some blood tests to check that your blood is clotting correctly, among other things. You will be admitted to hospital an hour or two before surgery. You should not eat or drink anything for 6 hours before this.
A specialist anaesthetist will give you some light sedation, and your palm will be administered with local anaesthetic. In some patients (for example, the extremely anxious) surgery is performed under general anaesthesia (ie. asleep). You will have some antiseptic solution painted on your hand, and a small incision will be made in your palm, usually in a skin crease. Using magnification, your surgeon will then carefully divide the tissues which are compressing the nerve. This will take around 20-20 minutes. Once the nerve is lying freely without any constriction, the skin is closed and a dressing applied.
What are the specific risks of this surgery?
Like any type of surgery there is always a chance of developing a complication. These risks are low in carpal tunnel surgery.
The most common complications are wound infection (treated with antibiotics) and haematoma (blood clot).
There is a very small risk (less than 1 in 100) of damage to the nerve, which may cause permanent weakness and/or numbness. Another uncommon complication is "bowstringing" of the tendons in the hand, which make require hand therapy and/or further surgery to rectify. Another postoperative problem that sometimes occurs is wound hypertrophy, or thickening. In most cases the tenderness associated with the wound settles down over several months and does not cause any long-term problems.
What are the risks of anaesthesia and the general risks of surgery?
- Significant scarring (‘keloid’)
- Wound breakdown
- Drug allergies
- DVT (‘economy class syndrome’)
- Pulmonary embolism (blood clot in lungs)
- Chest and urinary tract infections
- Pressure injuries to nerves in arms and legs
- Eye or teeth injuries
- Myocardial infarction (‘heart attack’)
- Loss of life
- Other rare complications
What happens after the operation?
You will have to wear a hand bandage for 4 days (your GP should check your incision at that stage), and should keep your hand elevated for the first 48 hours. The sutures will be removed around 12 days after surgery by your GP or the Precision Neurosurgery Practice Nurse.
You will be able to use your hand in a progressively normal fashion, but should avoid significant repetitive hand movements, direct pressure over the incision, and heavy lifting for at least 3 months.
You will be given more detailed instructions about incision care before your surgery.
What should you notify your doctor of after surgery?
- Swelling, redness, increased temperature, or possible infection of the wound
- Weakness or numbness of the hand or fingers
- Hand swelling, temperature changes, or discolouration
- Any other concerns
What are the results of surgery?
Carpal tunnel decompression is successful in the vast majority of patients, and significant complications occur in a very small minority.
What are the costs of surgery?
Private patients undergoing surgery will generally have some out-of-pocket expenses.
A quotation for surgery will be issued, however this is an estimate only. The final amount charged may vary with the eventual procedure undertaken, operative findings, technical issues etc. Patients are advised to consult with their Private Health Insurance provider and Medicare to determine the extent of out-of-pocket expenses.
Separate accounts will be rendered by the anaesthetist and sometimes the assistant, and hospital bed excess charges may apply. Medical expenses may be tax deductible (you should ask your accountant).
You should fully understand the costs involved with surgery before going ahead, and should discuss any queries with your surgeon.
What is the consent process?
You will be asked to sign a consent form before surgery. This form confirms that you understand all of the treatment options, as well as the risks and potential benefits of surgery. If you are unsure, you should ask for further information and only sign the form when you are completely satisfied.