If you have been diagnosed with carpal tunnel syndrome (CTS), this leaflet will help you understand the procedure, recovery and advice following surgery.

Surgery

CTS surgery is an operation to relieve the symptoms of CTS by dividing the ligament in your wrist that runs across the top of the wrist bones and creates a narrow channel in the wrist.

This decompresses the nerve.

The surgery is typically carried out under local anaesthetic.

After surgery, as with any procedure, you are likely to experience discomfort or pain after the anaesthetic wears off.

Recovery after surgery

Everyone recovers differently and recovery also depends on how severe the CTS was before surgery.

After the first couple of days, you may experience:

• pain around the wound
• stiffness
• swelling
• weakness in the grip
• nerve irritation.

One to three months after surgery, you can expect to return to everyday activities and continue working towards full strength in your hand.

Scar and wound care

Scars are produced as part of the body's normal healing process.

They may become red and raised.

The scar can take between 18 months and two years to fully mature.

If you are seeing the nurses or wound clinic for your wound, they will provide the support you need and will monitor the healing process.

If you have stitches, not including dissolvable stitches, they are normally removed after two weeks by the clinic where you had your surgery or by the wound clinic, who will also manage the bandages.

However, we recommend that you look out for signs of infection that could potentially delay healing.

Signs of infection

• yellow or green discharge or pus
• swelling, redness or skin that feels hot to touch
• a strong smell
• concerns that your wound may be infected.

If you are worried that your wound might be infected, please contact the service caring for you, for example your GP, wound clinic or nurse if your surgery was carried out privately.

Once the wound has healed fully and non-dissolvable sutures have been removed, usually two to three weeks after surgery, use your other hand to apply a small amount of non-perfumed moisturising cream to the scarred area.

Do not use Savlon cream.

If the wound is closed and you have dissolvable sutures, you can commence scar massage at this stage.

Technique and advice

• massage in circular motions and move vertically and horizontally across the scar
• try to apply enough pressure to blanch or lighten the scar
• you can press more firmly as it becomes comfortable, but not so firmly that your skin becomes sore or opens up
• try to move the skin away from any underlying tissue it is stuck to, but do not expect to release it completely
• massage at least four to six times a day for two minutes each time
• continue to massage until the scarred skin feels similar to the rest of your hand, for example soft and mobile
• cover new scars in the sun or use a high-factor sunscreen.

Scar sensitivity

Sometimes after surgery, the skin can become hypersensitive.

To improve this, desensitisation is recommended.

How is it done?

• controlled application of different textures, such as cotton or silk, or movements such as vibration, tapping or stroking
• it is important that you are relaxed so you can concentrate on each texture or movement
• practise little and often, up to four times a day.

Desensitising programme

Massage

Using moisturising cream such as E45 or aqueous cream, make small circles around and on the sensitive area or scar.

Gradually increase the pressure over the next few days as the area becomes less sensitive.

Texture massage

Use different fabrics at home, up to four different textures.

Start with the most comfortable fabric and gently stroke the material over an unaffected area so that you can remember what the feeling should be like.

Then start on the edge of the affected area and work inwards, making small circles over the area for about one minute.

Repeat the process with a different texture.

Immersion massage

Choose different dry ingredients such as pasta, lentils, beans or rice.

Start with the least aggravating ingredient by immersing your hand in it.

Do this for up to five minutes.

As it gets easier, choose a different ingredient.

Vibration or tapping

Using your finger, gently tap the affected area, or use a mini massager or the end of a toothbrush.

Gradually build up the intensity of the tapping.

Oedema

After surgery, swelling, known as oedema, can be expected and is part of the healing process.

However, if it is persistent, it can delay healing.

Management of oedema

Elevation

Keep your hand elevated when not using it during the daytime.

Elevate and pump your hand.

Ice

Apply ice safely by wrapping it in a tea towel before use for five to 10 minutes.

Do not apply ice directly to the skin as it can damage the area.

Contrast bathing

This method should only be used once the wound is fully healed to avoid the risk of infection.

Contrast bathing helps stimulate circulation in the affected hand, encouraging blood flow and helping reduce swelling.

• use one bowl of warm water and one bowl of cold water
• place your hand in the warm water and perform gentle finger exercises, such as making a fist and releasing it, up to 10 times
• place your hand in the cold water and rest for one minute
• repeat this four times, which should take approximately six minutes.

This process can be completed up to four times a day, depending on the level of oedema.

Exercises

Wrist range of movement – bend wrist forwards and backwards

• rest your elbow on a table
• gently bend your wrist downwards, aiming to move your palm towards your forearm
• then bend your wrist backwards, aiming to turn the palm upwards
• do _____ repetitions.

Wrist stretch

• place your hands together under your chin in a prayer position
• push your hands down towards your waist until you feel a comfortable stretch
• hold for _____ seconds
• do _____ repetitions.