Indications:
This procedure is indicated for Carpal Tunnel syndrome unresponsive to conservative treatment including 2 steroid injections with significant functional disability.
What to expect before surgery
If you are to undergo this procedure with Dr Bala, you will usually consult a member from the anaesthetic team a few hours prior to the surgery. You may be required to bring some of your more recent investigations including a chest x-ray, ECG and routine blood tests. If required the nurse or physician may order more tests if required. The procedure is usually performed under general anaesthesia. It may also be performed under WALANT (Wide Awake Local Anaesthesia No Tourniquet) although indications are limited. The anaesthetist may further discuss these with you. The procedure and anaesthesia are usually for half an hour. Carpal tunnel release surgeries are day surgery procedures meaning you will usually go home the same day should you be well.
The nurse will instruct you on the time you should start fasting prior to the surgery start time, the reporting time into the hospital and the possible discharge time. It may be possible to shower the night before surgery and remove jewellery, especially bracelets and rings at home.
On the day of surgery
It is good to report a couple of hours prior to the scheduled operation time to enable time for you to change into the hospital gown and be reviewed by the anaesthetist and the surgeon. The only prick you might feel is that of the IV line prior to anaesthesia. A ‘timeout’ is done to ensure that the entire team is satisfied with the side, procedure and equipment. The anaesthetist will give you some sleep medicines 1st to make you comfortable and you may request for your choice of music as drowse off to sleep. You will also be given an electrical warming blanket to ensure your body remains warm during the duration of the surgery. Some surgeons prefer to give the WALANT a good half an hour before the scheduled start of the case. An IV antibiotic (usually cefazolin) may be administered prior to surgical incision if you are a diabetic.
Surgery
Anaesthesia is usually given on the operating table. An ordinary table with a radiolucent hand table attachment is used. The procedure is done with you lying on your back. Once you are comfortably positioned on the operating table with adequate cushioning, a C arm is used to check to see if the fracture is visible. A tourniquet is applied which is like a blood pressure cuff to keep blood out of the field of surgery to help improve visibility of important structures. Then the operating side is cleaned and draped. The upper limb is drained of blood using an elastic band called an Esmarch bandage and the tourniquet is inflated to keep blood out and the procedure is begun. The procedure maybe done open or keyhole. On most occasions Dr Bala prefers to do it open to visualize and free the nerve being compressed. The operated area is cleaned and a compressive waterproof dressing is applied to soak up the ooze. An outer dressing is usually applied to the wrist or hand. Very rarely after Dupuytrens release, a plaster splint maybe applied to correct the residual deformity. A collar and cuff sling is usually provided to support the wrist and hand after surgery. The drapes are removed and you will be shifted back to the trolley from the operating table after the procedure is complete.
For more details of specific procedures performed you may visit the following pages of this website
Carpal tunnel syndrome https://pradeepbala.com/conditions-treated/carpal-tunnel-syndrome/
Trigger finger https://pradeepbala.com/conditions-treated/trigger-finger/
Dequervains tenosynovitis https://pradeepbala.com/conditions-treated/de-quervains-tenosynovitis/
Dupuytrens contracture https://pradeepbala.com/conditions-treated/dupuytrens-contracture/
After surgery
You are usually kept in the observation bay in the operating theatre for a couple of hours and usually discharged directly from the theatre. Once you are fully awake, have had a few sips of water without throwing up, can move all of your fingers comfortably without pain you may be discharged.
Dr Bala may either phone your closest relative or see you before you are discharged.
Follow up
You will be allowed to remove the outer dressing after 3 to 5 days and shower if you have a waterproof dressing on. In the event of external sutures, you may wash it with soap and water. The physiotherapist will instruct you to as to what movements you can and cannot do after surgery. Dr Bala sees his post op patients at around 2 weeks after surgery. There maybe a few sutures to remove, if at all. You may require some sessions of hand therapy after surgery to optimize the function of your wrist and fingers. Dr Bala will review you at 2, 6 and 12 weeks.