Carpal tunnel syndrome is numbness, tingling, weakness, and other problems in your hand because of pressure on  the median nerve in your wrist. The median nerve and several tendons run from your forearm to your hand through a small space in your wrist called the carpal tunnel. The median nerve controls movement and feeling  in your thumb and first three fingers (not your little finger). Pressure on the median nerve causes carpal tunnel syndrome. This pressure can come from swelling or anything that makes the carpal tunnel smaller. The surgical procedure to decrease pressure on the median nerve is to release a ligament at the base of the hand.

What to Expect After Your Carpal Tunnel Surgery

Your surgery site:

• Immediately after surgery, a bulky dressing will be placed on your hand and wrist. This is to minimize swelling from surgery. Your dressing should be kept clean and dry. The dressing can be removed 1 day after surgery, and the hand lightly cleaned with soap and water. The incision should not be soaked in water, such as a in a bathtub, or vigorously rubbed to clean. You may dry the incision by patting it lightly with a clean, dry towel. A new, clean dressing should then be applied over the incision, such as a band aid. Dressings should be changed daily and as needed for any bleeding or drainage.
• The incision should be inspected daily, and any abnormal drainage or excessive bleeding should be reported immediately.
• You will be scheduled to see a hand therapist approximately one week after your surgery. Your sutures will be removed at that time and range of motion exercises will be practiced.  Scar massage will also be started at that time if you are well healed.  Typically, you see a hand therapist for 1-3 visits.  Their goal is to make sure your motion and function returns well.

Post op Pain and Swelling:

• Elevate your hand to decrease swelling and discomfort. Mild to moderate swelling is expected after surgery. Your hand should be elevated above your heart to minimize this.  Gentle hand fisting and opening after you have removed your bulky dressing, will have decrease swelling. Heavy lifting or activity should be avoided until after your hand therapy follow up appointment.
• You will be prescribed a narcotic pain medication for pain medication for pain management. Please take this as directed, and do not exceed the recommended dosing. Try to wean down as tolerated. These medications can cause constipation and you may want to use an over the counter stool softener. Tylenol products may be used instead of the prescribed pain medication but should not be used with the narcotic pain medication as they both contain acetaminophen, and overdose can occur.
• Ice may be applied to the surgical area to help with pain, avoid direct contact with the skin, as this may result in damage to the skin. Instead, wrap an ice pack or bag of ice in a towel before placing on the hand. You may ice your hand as often as you prefer but allow 20-30 minutes between ice applications.

Driving:

You should not drive if still taking narcotic pain medication. You also must feel strong and alert and be able to grip the steering wheel with both hands.

Things to watch for:

Occasionally patients experience troubles after surgery and need additional medical attention. Call your therapist or surgeon if you experience any of the following

• Fever of greater than 101 degrees F
• New or different colored drainage from your surgical incision
• Chest pain or shortness of breath -Seek medical attention immediately if you develop sudden chest pain, shortness of breath, a rapid heartbeat, lightheadedness or dizziness.

Activity:

It is generally recommended avoid lifting things heavier than 5# for the first 2 weeks after surgery to minimize hand swelling. This includes doing repeated arm or hand movements, such as typing or using a computer mouse, washing windows, vacuuming, or chopping food. Do not use power tools and avoid activities that cause vibration. At 2 weeks post you are asked to restart “activities as tolerated”. Your hand therapist can provide you with additional activity guidelines.

You may do heavier tasks about 4 weeks after surgery. These include vacuuming, mowing the lawn, and gardening.

The surgery to reduce thumb pain due to arthritis is to remove the arthritic bone that is the pain generator. The surgeon creates a support to maintain the length of the thumb and the body uses scar tissue to create a stable thumb base. Progressive thumb motion is allowed over several weeks.

What to expect after your thumb surgery

During your surgery, your surgeon removes a small bone (the trapezium) at the base of the thumb. The surgery also includes building support 

with the surrounding soft tissue structures to keep the thumb in proper position for function. These structures will require healing time. The goal after healing is to be able to use your thumb with less pain. Typically, you are in a post operative dressing that supports your wrist and thumb for 2 weeks. Weekly hand therapy is recommended and begins at 2 weeks after surgery. Most patients are commonly off work for at least 1-2 weeks then on restricted duty for 2-3 months. Restricted duty restrictions initially includes: No pinching, light use only of the fingers, no lifting more than 1 pound, wearing a cast or splint for 2-3 months

Week 1: During the first week after surgery, you can help minimize swelling by keeping your arm elevated above your heart as much as possible. Finger exercises will also help keep swelling down and help keep your fingers flexible.

In Therapy: You will be taught how to advance safe movements and functional use.

Week 2: You will see your surgeon and your hand therapist approximately 2 weeks after surgery. You will have a forearm based thumb splint made. You will be allowed to shower with your splint off. Don’t soak your hand. You will continue finger exercises and use elevation as needed. You may be given an elastic sleeve to help with swelling. You will be shown gentle scar massage. In the healing process, the body uses scar tissue to restore stability to the base of the thumb. The first 4 weeks are when the “new joint” forms.  The heavy scarring stage lasts for the first 2 months.

Week 3-5: Pain management and swelling management are likely still needed.  Thumb exercises will be added each week. Do not combined bending your wrist and thumb together. Do not try to push your palm and thumb flat on the table. A scar pad will be provided for use at night with your splint. At about 5 weeks post surgery, wrist motion will be added to your home program

Week 6: You will be allowed to come out of your splint to use your thumb in day to day tasks such as getting dressed, eating, and light house work such as folding laundry. As you come out of your splint you will be asked not to try to flatten you palm on the table. That puts too much stress on your thumb.

Week 8-10: You will use your plastic splint for at-risk activities involving forceful pinching/gripping. You will be shown thumb stability exercises and joint protection. There may be a need for a neoprene thumb splint as a means for joint protection.  Gentle hand strengthening will be initiated as needed. Your therapy ends around 10-12 weeks post but your hand function will continue to improve for several months.

The radial nerve, ulnar nerve and the median nerve can become compressed at the elbow forearm area. If a surgical release is indicated, the surgeon will make an incision the area where the nerve is compressed. The nerve is decompressed, and the limb is moved to ensure the nerve moves freely. Maybe use medial forearm image 66efd9ee.  maybe photo 9cdca67d later view of forearm. Short term hand therapy is often recommended after surgery to learn nerve gliding exercises and manage scar tissue as it forms.

Diseased palmar fascia, banding and nodules that cause the fingers to curl into the palm are removed. The involved fingers are splinted straight. The splint is used at night for up to 3 months. There is surgical techniques and non-surgical injection that can manage the hand contracture.

Severed tendons of the hand and finger need to be repaired to have fingers move correctly.

Cysts at the wrist area or the finger can be painful and interfere with function. When this occurs surgery may be recommended.

Fractures of the arm, wrist, hand and finger can be poorly aligned or unstable. These conditions can result in a bone that heals in a poor position for function or a bone that doesn’t ever heal resulting and pain and poor function. If your fracture shows a tendency for a poor functional outcome, surgical stabilization will be discussed with you by Dr. Moen. She will explain the risks and benefits to surgery as it pertains to your fracture and to your future hand function needs and goals.

At times painful joints limit function to the point where a joint fusion needs to be considered. The joint is stabilized for a length of time to allow the joint to heal together. There will no longer be motion in the joint and there will no longer be the joint pain that occurs with motion. There are times when fusing the joint results in increased hand function. Dr. Moen will explain the benefits and draw backs from a joint fusion as it is considered.

This is inflammation of 2 tendons in one sleeve located at the base of the thumb. Treatment can include a wrist thumb brace, thumb injection or if needed surgery. Surgery would open the sleeve so there is more room for the 2 tendons to slide and move as the thumb and wrist move.

At times a finger can get caught in the pulley system that holds tendons near the bones of the finger. You will have trouble straightening your finger. Treatment can include splinting, icing, cortisone injection or surgery to release the pulley so that the tendons can move freely.