Preoperatively, the patient is educated about the expected clinical course following carpal tunnel release. Specifically, they are warned about incisional tenderness for 8-12 weeks postop. Although nighttime symptoms are often relieved immediately, other symptoms, such as constant numbness, weakness or clumsiness are due to nerve damage. These will resolve very gradually, and recovery may be incomplete. The patient should be counselled regarding activity modification and possible impact on employment. The patient should also be instructed on the isolated tendon gliding exercises to be initiated postoperatively.
Gentle exercize and light use of the hand is encouraged beginning the day after surgery. The bandage and stiches are removed about a week after surgery. The palm is tender for at least four to six weeks after the procedure. Golf and hand - related sports are usually too uncomfortable until six to eight weeks postop.
Patients planning to return immediately to strenuous activities may do so in a short arm cast or strong clamshell splint - 30 degrees wrist dorsiflexion, basal joint immobilized. This is worn for one month.
The effects of scar tissue shrinking and maturing result in adhesions which pull on the median nerve and often result in brief shooting or electrical pains with motion, particularly when the patient stretches their hand out to reach an item at arm's length. Sudden shooting or electrical shock pains may also occur spontaneously while the patient is doing nothing. Both of these are normal occurrences and improve with time.
The shrinking and swelling associated with scar maturation results in the feeling of a lump at the base of the palm at the proximal end of the incision. This is most noticeable when the patient leans on the hand while going from a sitting to standing position. This is normal and improves with time and with massage. The patient is given a therapy to make your hands less tender handout.
Grip strength is normally reduced for two to three months following surgery, but full recovery is expected.
It is normal for the mid-proximal palm to be most tender and most sensitive to the touch during the interval of time from two to six weeks following surgery.
The patient is given clearance to resume light activities within their own tolerance, including driving, as soon as they feel comfortable enough to do so. They are encouraged to use common sense and avoid activities which hurt. They are normally seen for a follow up visit four to six weeks following surgery.
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