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Carpal tunnel decompression

Treating carpal tunnel syndrome: non-surgical and surgical options

Carpal tunnel syndrome is common, and therefore decompression surgery is a common surgical procedure. Below, we go over some of the background facts so you get a better understanding of the syndrome and possible treatment options.

carpal tunnel decompression perth

Carpal tunnel syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome affects one of the main nerves that supplies your hand, the median nerve. This nerve crosses into your wrist under a tight band (the transverse retinaculum), and this is where it is typically compressed. As a result, you may experience:

  • Numbness and pain in your thumb, index, middle and (sometimes) your ring finger, but typically not your little finger.
  • Pain at night that results in you having to dangle your hand or “shake it to wake it”.
  • Pain in certain positions, eg when holding the steering wheel with a flexed wrist.
  • After a while, weakness with grip strength so that you may start to drop things without warning.

Carpal tunnel syndrome is a common condition. It causes typical numbness in your median nerve distribution. Age is the most common contributing factor, but you can also develop the condition during pregnancy or if you have a thyroid condition.

Avoid surgery for carpal tunnel syndrome

Can I avoid surgery?

In some cases, we will have a conversation that focuses on exploring ways to avoid, postpone or defer surgery. If you have carpal tunnel syndrome, it is important to understand what aggravates the nerve, and ways to relieve your symptoms without surgery. 

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Mark Hurworth - Orthopaedic surgeon Perth

Mr Mark Hurworth, Orthopaedic surgeon Perth

“In particular, splinting the wrist at night in slight extension is often an early treatment avenue, combined with a steroid injection to reduce inflammation.”

Modifying activity can also be useful, in particular:

  • training yourself to change the way you apply pressure on your wrist, as you go about daily activities such as driving your car or riding your bicycle.
  • the use of vibrating tools can sometimes lead to the onset of symptoms, and therefore ceasing to use these tools can lead to resolution of symptoms

If a thyroid condition is the cause of your carpal tunnel symptoms, then treatment of the underlying condition can sometimes resolve the problem.

If pregnancy is causing your condition, then it may resolve at the end of your pregnancy.

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Carpal tunnel decompression surgery

What type of surgical treatment is available?

If nonoperative treatment has not resolved your problem, then we may discuss carpal tunnel decompression.

This means we surgically release the contents of the carpal tunnel (in particular we are releasing the median nerve that is compressed). I usually perform this surgery through a small 3 cm incision. It means that I can see the carpal tunnel and its contents directly. I specifically do not perform endoscopic carpal tunnel surgery (surgery that pushes a camera into an already tight tunnel with a nerve in it) because there is a higher risk of damage to the nerve.

Carpal tunnel decompression risks

What about risks?

The major risk of this type of surgery is nerve damage, in particular small branches can come off at different places ie there is some anatomical variation – another reason why I don’t use an endoscope.

There are branches of your median nerve in this area that are important for function and motion: the motor branches supply most of the thenar muscles, the intrinsic muscles of your thumb. They control thumb motion, therefore any damage to these branches can result in problems with grip strength in particular.

Other risks include complex regional pain syndrome and wound infection. We will discuss the risks in more detail when we consider your treatment options.

Recovering after carpal tunnel decompression

How can I get the best outcomes after surgery?

As with all orthopaedic conditions, movement is essential. In a nutshell, keep the wrist and hand moving before your wrist surgery and after your surgery. You are able to use the hand even though it may be bandaged for the first 2 days and have a waterproof dressing on it for 2 weeks – just don’t overdo it.

After your surgery, you will hear us use the acronym RICE, which stands for:

  • Rest
  • Ice
  • Compression
  • Elevation (for the first 48- 72 hours)

Your surgical wound would normally take 2-3 weeks to heal, so if your job involves any manual or heavy work, it is best to allow three weeks before returning to work.

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