Hi, so carpal tunnel syndrome.

I’ll just tell you a little bit about what that means.

So carpal tunnel syndrome is a problem with pressure on the median nerve.

The median nerve itself actually starts in the neck.

Its roots go through the brachial plexus, and then the nerve travels down the arm and through the wrist and out into the hand itself to supply functions within the hand itself.

So this median nerve, when it’s compressed in the carpal tunnel, causes what’s called carpal tunnel syndrome.

The carpal tunnel itself is formed by bones at the back of the wrist in a U-shape, and then a ligament across the top called the transverse carpal ligament.

Those things fit together to create the tunnel.

The nerve passes through that.

When the nerve is under pressure within that carpal tunnel, which can be caused by various reasons, you then have a condition called carpal tunnel syndrome.

Carpal tunnel syndrome itself actually causes symptoms within the distribution of that median nerve.

That nerve supplies sensation to the thumb, index, middle and this half of the ring finger.

It doesn’t supply that half, and it doesn’t supply the little finger.

It also supplies some grip muscles in the hand and also some of the pincer muscles here as well.

So, if there’s a problem with the nerve, then you can lose pincer function and you can lose grip strength and you can get altered sensations in that part of the hand, this is carpal tunnel syndrome.

It is treated by taking pressure off the nerve.

This is done by putting some local anaesthetic into the wrist and the hand here.

Then, once that anaesthetic has worked, we open up the skin down to that transverse carpal ligament, which is then cut and it pings open, which allows the pressure to come off the nerve.

The nerve will then recover and heal of its own accord.

As it heals, the sensation should return, as should the function within the hand.

Muscle atrophy, however, tends not to recover.

So you may have a reduced bulk of muscle in that hand long term.

However, the grip function should at least be preserved from where it is, if not get some improvement.

There are risks, of course, with any type of operation.

In the case of carpal tunnel decompression, those risks include infection, bleeding and the risk of nerve injury.

The risk of nerve injury is rare, but if it does happen, it can affect, permanently, the function or sensation in the hand.

And also, there is a risk of infection, as with any operation, infection and bleeding.

If it bleeds, then we can have collections within the hand or it can bleed outwards.

But all of this is usually self-resolving or can be easily treated, particularly superficial infections.

Deep infections are rare, but would need surgical intervention further along the line.

The other risk to be aware of is something called complex regional pain syndrome.

Complex regional pain syndrome is unusual.

It’s rare.

I’ve not really seen it very often, if at all, really.

But when it does happen, it can affect the whole of the arm.

This will cause pain, swelling, stiffness and weakness throughout the whole of the limb.

It is quite debilitating, but it is rare.

Treatment for it actually is based on exercise and elevation, which you should be doing anyway.

As long as you do that, it should help avoid having those problems in the first place.

The other risk is something called pillar pain.

This is pain on either side of the hand, at the pillars of the hand, and this is most likely part of the healing process.

This pain itself is uncomfortable, but can be more severe.

There is discomfort when you press on it. It may also hurt when you put pressure on it as well.

This should hopefully settle.

In terms of complex regional pain syndrome, we’d expect that to have resolved within two years, but it could persist.

In terms of pillar pain, we’d expect that to be settling by six months.

But again, potentially it could persist.

These are the risks of the procedure.

The procedure we do is done under local anaesthetic.

We usually put some adrenaline into the local anaesthetic as well, and you are awake as well.

So you may feel some movement, but no pain once the anaesthetic has kicked in.

The other thing that you need to be aware of is that the purpose of the operation, my job, the surgeon’s job, is to take pressure off the nerve.

Subsequently, the body has to do all the healing, and that healing process is variable for everyone.

So it depends on how quickly and how well you heal as to how much recovery and how quickly you get that.

The other thing to be aware of is that the hand is out of action for a few weeks initially because it is bandaged and you’ve had surgery.

That should resolve quickly.

It takes a few weeks to get the function in your hand.

So if there’s something that you’re going to be doing, it can take six to eight weeks to be able to get to a point where you’re able to do manual work.

After that six to eight weeks, we expect most people, 85 to 90 per cent of people, to use their hands fine with no awareness that the healing process is still ongoing.

However, about 10 to 15 per cent of people will be aware of things like pain, swelling, stiffness or weakness that could last six months or even persist longer than that.

For most people it will settle gradually over that period of six months. However, for those who it persists, be aware that the healing process generally takes around two years for most people.

However, long-term healing can also be a problem.

Driving shouldn’t be undertaken until you can grip a steering wheel properly, but that usually takes more than two weeks.

It is rare, but it can happen quicker, but in most cases it takes longer.

During the procedure, we may have to do some other things which become apparent whilst we’re in the middle of the procedure.

If that happens, because you’re awake, we can discuss that with you.

However, if for whatever reason you have fallen asleep or passed out, then we will do only medically indicated things.

Those are the main risks.

There may be other risks that we need to discuss with you directly and separately.

I, or one of my colleagues, will discuss those with you at the time, specifically for your personal circumstances.

And once we’ve done that, we can look at moving forward to surgery.

Thank you.