Post operative Instructions
Click on the link to view the instructions of your operation. You may want to print out a copy of your operation.
Carpal Tunnel Decompression
0-5 days after surgery
Gentle exercise and light use of the hand is encouraged beginning the day after surgery. Finger motion (full extension and flexion) is important for all fingers. Resistive activities (i.e. squeezing a ball) are avoided for the 6 weeks following surgery.
1-6 weeks after surgery
The sutures are removed approximately 10 to 14 days after surgery by your GP. You may remove your dressing in 2 to 3 days after surgery.
You should start active range of motion exercises of the wrist. Avoid simultaneous wrist and finger flexion for 3 to 6 weeks (See Figure). However, the wrist can be moved through a range of motion.
Edema (swelling) control, scar massage and desensitization are initiated when the incision is healed. Scar massage can be started approximately 3 weeks after surgery if the wound has healed. Use a non-perfumed lotion (Vitamin E lotion is OK). Gentle but firm pressure is applied to the wound and massage in a circular fashion. This can be performed for a few minutes 5 times a day at first and over time less frequently as the tenderness improves.
The palm will remain tender for at least 4 to 6 weeks after surgery and mildly so for 6 months. Return to golf and hand sports is usually possible at 6 to 8 weeks. Likewise, impact loading to the palm should be avoided for at least 6 weeks after surgery. A padded glove (bicycle or weight lifting glove) may be helpful.
6-12 weeks after surgery
Start progressive strengthening exercises.
Although nighttime symptoms are often relieved immediately, other symptoms, such as constant numbness, weakness or clumsiness are due to nerve damage and may not be completely relieved. These resolve very gradually, and recovery may be incomplete. Maximum improvement may take 6 to 12 months. Occasionally, the numbness may be more obvious after surgery because the pain and tingling are improved.
Gentle exercise and light use of the hand is encouraged beginning the day after surgery. Tenderness around the scar usually lasts for 8-12 weeks after surgery. This may take 6 months to resolve completely.
You may not be able to return to all activities at home or at work immediately after surgery and activity modification and work modification may be necessary.
|Range of motion of the fingers is important after surgery and encouraged. It helps the nerve to glide so adhesions don't form. However, simultaneous wrist and finger flexion should be avoided for at least 3 weeks after surgery. (See Figure)
As the wound heals the scar tissue shrinks and matures. This results in adhesions that pull on the median nerve and often result in brief shooting or electrical pains with motion. This commonly happens when you stretch your hand out to reach an item at arm's length. Sudden shooting or electrical shock pains may also occur spontaneously while you are doing nothing. Both of these are normal and improve with time. Scar formation results in a lump at the base of the palm. This is noticeable when you lean on the hand or push off. This is normal and improves with time and massage. Leaning on your knuckles with the wrist in a straight position will help.
Grip strength is usually weak for 2 to 3 months following surgery. Full recovery is expected but may take 6 months.
You can resume light activities within your own tolerance, including driving, as soon as you feel comfortable enough to do so. Please use common sense and avoid activities that hurt. Suture removal is between 1 to 2 weeks and the next follow up appointment is made for 4 to 6 weeks after surgery
- Activity and Restrictions
- Wound Care
Maintain your regular diet.
You may use stool softeners, Panadol or Digesic as you need. Narcotic medication may be prescribed if you require these. You may also be given muscle relaxants. During the healing phase avoid any type of aspirin, aspirin-like products or anti-inflammatory drugs. These have been proven to decrease the healing rate.
- Activity and Restrictions
- If you have been given a brace, it is to be worn when out of bed. If the brace is irritating to your skin or your wound, it may need adjusting or refitted by the brace maker
- You should not drive until you are cleared by Dr Mobbs. Following such an operation, you may find that your reaction times are slow because of pain, generalized fatigue, stress of surgery, and prescribed pain medication. You may ride in a car and may find it more comfortable in a reclined position or in the back seat. If you are planning to take long trips, please try to take interval breaks, every 45 minutes, getting out of the car and walking short distances
- You may take short walks inside and outside of your home. You may use a walker if needed for comfort. You may go up and down stairs. Try to gradually increase the distance that you walk
- You are to avoid any heavy work, housework, shoveling and lifting of more than a few kilos, as well as any strenuous activity
- Do not begin any type of physiotherapy, an exercise program or sports program until you are instructed to do so. This would usually be at least 6 weeks after the surgery
- If you smoke, remember that smoking impairs healing of bone and thus slows or decreases the rate of your recovery, leading to poor results and NO FUSION. Smoking cessation will not only help you heal but will improve your general health!
- We do not recommend using hot packs to the lower back while you are healing. Hot packs will increase blood flow, increase swelling and increase discomfort early on in your healing phase
- Wound Care
- The majority of spinal fusion patients have their wounds closed with an absorbable suture. If you have staples, they need to be removed anywhere from 7 to 10 days from surgery by you local GP. You may have small steri-strip (mini band-aids) on the wound – let these fall off in the shower over 2-3 days when you get home
- The wound is to be kept clean and dry. You may shower after approximately 5 days after the operation, with an occlusive dressing. If the wound does become wet, please blot it dry and apply a new clean sterile dressing
- We recommend a clean dry sterile dressing on an 1-2 day basis until 7 days after the operation
- If you develop fevers, chills, draining from your wound or have unrelenting pain despite medication, please contact the rooms and leave a message for Dr Mobbs. If you develop increasing weakness of the legs or difficulty passing urine – please go to your nearest emergency department or contact the Neurosurgery Registrar at Prince of Wales Hospital on (02) 9382 2222