After you have undergone surgery for carpal tunnel syndrome, your post-operative course may vary depending on which particular surgery you had and whether you had complications. The success of the surgery will also depend on your symptoms and general health before surgery, which play major roles in determining how quickly you recover and return to your normal life.
Introduction
If you have elected to have surgery for carpal tunnel syndrome, you will have one of two types: open release or endoscopic surgery. They involve different techniques and also have different post-operative recovery courses. Both techniques are used to cut the transverse carpal ligament. This allows the carpal tunnel to open wider and decompresses the median nerve. The open release approach is more traumatic because it requires a 2-inch long slit in the palm. The endoscopic approach merely requires one or two small holes in the palm. Sometimes during the endoscopic approach, the surgeon will find that there is difficulty safely cutting the carpal ligament due to blood vessels or nerves in the way. At that point it may be decided to switch over to the open technique during surgery. Whichever approach is taken, the immediate post-operative course of events will be similar.
Recovery Room
If you were given general anesthesia you will awaken in the recovery room. If you were given a regional anesthetic you will have been awake for the entire procedure. In either circumstance, you will not feel much pain. You also will be given oral or intravenous analgesics for pain. Your hand will be bandaged and elevated above your heart's level to minimize bleeding. Once the doctor has determined you are stable you will be allowed to go home. If you had any complications, such as reaction to anesthesia, you may be required to stay in recovery longer or, depending on severity, in the hospital.
First Few Days
When you arrive home you will likely rest in bed for the remainder of the day. Your hand must stay elevated as before. You will be given a prescription for analgesics to treat the surgical pain and you will use ice packs to control swelling. You will spend the next day relatively immobile, although many patients begin to get around. It depends largely on the surgical technique used and on your general heath before surgery. Even though you will wear a splint most of the time you should avoid performing any taxing activities with your hands. You should refrain from typing and heavy gripping of any sort for up to about six weeks. Also, you must change your bandages and clean the scar area periodically. You also will be encouraged to move your hand and fingers, only minimally, to avoid adhesion formation.
Two Weeks Later
After approximately two weeks, you will be required to perform hand and finger exercises. You will start slowly and easily, and the exercises include range of motion, stretching and isometric maneuvers. These will strengthen your hand and fingers, control scarring and improve dexterity. More vigorous movements should not be attempted until about four weeks after surgery. You also will return to your doctor at about two weeks to remove stitches. Once the stitches are removed you will be encouraged to massage the scar area.
Longer Term
By four weeks you will begin heavier strengthening and other exercises. You also will begin to resume your normal daily activities, although with extreme caution so you do not aggravate your hand. Grip strength may take a long time to recover, assuming there were no surgical complications. Sometimes grip strength does not recover at all and it depends primarily on how severe your symptoms were before surgery. Depending on your progress, you doctor may prescribe physical or occupational therapy to speed you recovery and return to work. Full recovery will likely take several months and some people require up to a year. Full restoration of function is not guaranteed, and many people report being unsatisfied with their results.
References
- Orthopod: Open Carpal Tunnel Release
- Encyclopedia of Surgery: Carpal Tunnel Release
- "BMC Neurology"; Splinting or surgery for carpal tunnel syndrome?; A. Gerritsen; December 2110
