The Hand and Wrist Centre

Carpal Tunnel Release
 

• What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition where a nerve (which gives feeling to the thumb, index, middle and part of the ring finger) gets squeezed in the carpal tunnel of the wrist.  There are many causes for this but most commonly, the syndrome is caused by swelling in the tendons, which also pass through the same tunnel as the nerve.

This can lead to the symptoms of night waking with tingling in the fingers.  As the condition progresses, numbness becomes more common (both during the day and at night).  Eventually the numbness becomes permanent and may lead to complete loss of sensation in the affected fingers.  In addition to this if the condition is allowed to progress, loss of fine control of the hand can occur with paralysis of the muscles within the thumb.  This can be very debilitating.
 

• How is carpal tunnel symptom treated?
   

Firstly your hand will need to be assessed.  Very mild symptoms can occasionally be splinted, or if the symptoms have only been present for a few months, it may be appropriate to try a steroid injection into the carpal tunnel.

It is important that the correct diagnosis is made before treatment.  This may be possible to be made clinically by Dr Timms or Mr Tom Sharpe or the diagnoses may need to be confirmed with a nerve conduction study.  Both Dr Timms and Mr Sharpe perform nerve conduction study tests on patients whose symptoms are not clear or, in patients who have signs and symptoms of a second nerve entrapped at the elbow (cubital tunnel syndrome).
 

• How is carpal tunnel syndrome treated surgically?

Carpal tunnel syndrome may be treated under local anaesthetic using an open technique.
 

What are the advantages of open carpal tunnel technique?

Generally performed with a short scar open carpal tunnel release under local anaesthetic in our rooms.  

This avoids the need for a general anaesthetic and its subsequent recovery.  This is a safer option in those people with significant medical conditions.  Open carpal tunnel release is the safest way of performing this surgery.
 

• How long will I take to recover?

You can return to work if you have a desk type job, or are able to perform light duties, within a few days.  You will have bandages around your hand which you may take off yourself at 5 days. 

The stitches are generally removed at 10 to 14 days or may be Dissolvable .
 

• What activity can I do whilst I recover?

Gentle hand activity and performing routine gentle tasks.  It is good for your hands during the post-operative recovery to keep mobile.  Gardening, heavy lifting or heavy manual work should be avoided for approximately a month after surgery.  Our Surgeons will discuss this with you in your individual case.

In the first few days following your carpal tunnel decompression you will notice some initial improvement in your symptoms of numbness and in particular a significant improvement in night waking.  The median nerve which is affected in Carpal tunnel may take many months to recover, but as the weeks go by, gradual improvement will be noticed.  In severe cases it may take 6 months or longer for maximum recovery to occur.

    Dupuytrens Surgery
 

• What is Dupuytren’s Disease?

Dupuytren’s disease is a condition of the hand which leads to progressive flexion of the fingers. 

The condition is fibrotic in nature.
It was first described by Baron Guillaume Dupuytren in The Lancet in 1831.  It was thought to have been introduced into Anglo-Saxon races by the Vikings in 700AD. 

Generally it appears later in life.
 

• Is Dupuytren’s Disease curable?

Currently Dupuytren’s disease cannot be cured, but bent fingers can be straightened.
 

• If I have Dupuytren’s Disease, when should I have surgery?

Early nodules within the palm are not treated surgically.  These may be treated with steroid injections if they are painful or left alone.  Surgery is contemplated when your hand can no longer be placed flat on the table or when the first knuckle drop of the finger (PRP joint) starts becoming bent.  The exact timing of this is important.  This will be discussed with you by tour Surgeon.

 

• How is surgery performed?

Surgery is usually performed under a general anaesthetic or arm block anaesthesia as a day surgical procedure in Forte Hospital or Southern Cross Hospital.

A zig-zag incision is made over the chords and bands and these chords and bands are separated from the nerves and blood vessels of the finger under magnification. 

 

• Will my Dupuytren’s come back?

Since the underlying condition cannot, at this stage, be cured, Dupuytren’s often recurs.  Hopefully, this will be many years in the future.  Recurrent Dupuytren’s is generally amenable to further surgery.

Should you have further questions, please use the “contact us” facility below or telephone us to arrange a consultation with one of our Orthopedic Hand Surgeons.

      Ganglion Cyst Removal Surgery
 

• What is a ganglion?

A ganglion is a fluid filled sack which generally communicates with a joint.  The most common ganglions are those that occur on the back of the wrist (dorsal wrist ganglion).   They may also occur on the front of the wrist (volar wrist ganglion) or within the hand (normally a flexor sheath ganglion).
 

• Will a ganglion disappear on it’s own?

Some ganglions go up and down with time.  Ganglions that have been present for more than three to six months will not usually spontaneously disappear. 

 

• How are ganglions treated surgically?

Most ganglions are treated at the day surgical facility of Forte Hospital or Southern Cross Hospital under either a short general anaesthetic or an arm block.  An incision is made over the ganglion.  Any important nerves or structures are identified by your surgeon and preserved.
Wrist ganglions are dissected from the surrounding tissue and the neck of the sac, which communicates with the wrist joint, is also removed.  This minimises the chance of recurrence of the ganglion.

Ganglions within the hands need to be removed carefully and the important nerves of the hand are identified and preserved by your surgeon prior to removing the it.  After the ganglion is removed and stitched a soft crepe dressing is applied.
 

• How long will it take for me to recover?

The dressing is required for the following five days to keep the hand comfortable.  Gentle activity is recommended following surgery but no heavy manual labour before three to four weeks.
 

• When can I return to work?

Most people can return to work within a few days if they perform the light duties or desk type jobs.


If you require further information, please contact us via the email facility on this website or telephone us on (03) 379 5060

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Tendon Reconstruction & Repair    Trigger Finger Surgery    Nerve Compressions