Following surgery which is undertaken under local anaesthetic, it can take 6-9 months for the ultimate plateau of recovery to come through. There is a very small risk of recurrence, infection in the wound, tenderness in the scar in relation to a neuroma of a cutaneous branch of the nerve. Pain and stiffness (reflex sympathetic dystrophy) can occur in a tiny percentage of interventions on the hand. If motor changes have occurred with wasting of the muscles around the thumb for example, then there is a chance that the changes may be irreversible. Whilst we would embark on surgery to improve symptoms and function, it may well be that this recovery is therefore incomplete. In patients where the entrapment of the median nerve in the wrist is a longstanding one, it may be that the early aftermath of surgery can lead to some unpleasant sensations, which paradoxically can be worse than the pre-operative state. However, in general these tend to settle down. If osteoarthritis of the hand co-exists with carpal tunnel syndrome and in particular if it is at the base of the trapeziometacarpal joint then it can lead to some delay in recovery and in particular in relation to the thumb movements.
Carpal tunnel syndrome over the age of 40-50 can co-exist with problems in the cervical spine. The purpose of carpal tunnel decompression is to remove from the sum total of the picture the contribution coming from the carpal tunnel but it may well be that there is a residue of symptoms coming from the neck which needs to be addressed. The clinical examination is essential in identifying, which is the more dominant contributor to the sum total of the clinical picture.
The outer layer of skin in the palm is keratinised skin, which has no blood supply and which is dry. Thus when the sutures are removed this area is very dry and it flakes. This is absolutely normal and is not a sign of infection. This can leave a slight groove in the wound known as “canoeing” and which always heals up without any problem. Patients often notice a pain over the site of the incision, the so-called heel of the hand. That is normal and due to the surgery that has been undertaken.
It is also common to notice bruising tracking down the forearm. This is accentuated by the fact that we always ask patients to elevate their hand and this causes any bleeding to track downwards towards the elbow. This bruising always settles down.
The procedure involves releasing the carpal ligament, which is the roof of the tunnel through which the median nerve and the tendons runs through.