CARPAL TUNNEL SYNDROME A PATIENT GUIDE TO THE NURSE-LED CARPAL TUNNEL SERVICE

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1 CARPAL TUNNEL SYNDROME A PATIENT GUIDE TO THE NURSE-LED CARPAL TUNNEL SERVICE Information Leaflet Your Health. Our Priority.

2 Page 2 of 6 What is carpal tunnel syndrome? It is entrapment of a nerve at the wrist which supplies sensations to the thumb, index, middle and half of the ring finger and also supplies the muscles near the base of the thumb. It is more common in women than men and affects both hands in a high percentage of cases. What are the symptoms? Numbness or tingling in the hand especially at night, whilst reading, driving or on the phone. Clumsiness in handling objects. Pain that goes up to the forearm. The hand may feel like it s asleep especially in the morning. Decreased grip strength. What causes it? Common causes and associated conditions: Most cases have no known cause. Broken or dislocated bones in the wrist will produce swelling. Arthritis, especially the rheumatoid type. Thyroid gland imbalance. Diabetes. Hormonal changes associated with pregnancy or the menopause. How is it diagnosed? A history of the problem is obtained. Your description of symptoms. Physical examination. In some cases a special test called a nerve conduction study (EMG) may be recommended to determine the severity of the pressure of the nerve this can be done during your appointment with the nurse. How is it treated? Mild cases may be treated by the use of a splint worn at night. By the administration of medication taken by mouth called non-steroidal anti-inflammatory drugs. Injection of a steroid into the hand can be used in a few cases.

3 Page 3 of 6 Surgery, to release the pressure on the nerve. Referral to the nurse led carpal tunnel service Seen by a specialist nurse in clinic. Diagnosis confirmed. Explanation of the service being offered to you and an appointment for surgery made to suit your needs. Surgery Performed under local anaesthetic. Performed by the Nurse Clinician Louize. Performed in a day case setting so there is no need to stay overnight. Performed through a small (3 cm) incision in the palm of your hand. The incision is closed with a choice of stitches which can either dissolve or have to be removed after 10 days by your GP. Carpal tunnel release BENEFITS Relief of symptoms RISKS Infection of wound Damage to nerve Reaction to medication No symptomatic relief Please discuss these with the specialist nurses. Prior to surgery Arrive at the time allocated to you. You will meet Louize, the Nurse Clinician and have the opportunity to ask any questions. Following an in-depth explanation, you will be asked to sign a consent form and the hand to be operated on will be marked with an arrow. ( ) Following surgery You will have 3-4 stitches (removable or dissolvable) surrounded by a bulky dressing. You will be given a small dressing to take home with you when you leave the ward. After 2-3 days you need to take the large dressing off and recover the wound and stitches with the smaller, easy to apply dressing. You still need to keep the dressing and wound dry until 10 days after your operation. If your stitches are removable they will be removed 10 days after the surgery either at your GP surgery or at the hospital the choice is yours. Either way, you should be given an

4 Page 4 of 6 appointment for this before you leave hospital. If you do not have one please contact Louize. Once the stitches are removed and the wound is healed you may bathe as normal. If your stitches are dissolvable, you will not need to see anyone and you can take your own dressing off after 10 days. At this point you may bathe as normal. Please feel free to contact Louize at any time during your treatment with any problems or questions on the numbers given. After your operation you may find you have some swelling or bruising around the wound and that some bleeding may occur. Keeping your hand elevated where possible for the first few days will help to reduce this. There may be some discomfort following the surgery which can usually be controlled with pain killers; however, if your pain is severe and constant, or you experience severe redness or heat around the wound, you should contact your GP or out of hours service. Rehabilitation Symptoms can be relieved almost immediately or within a short period of time. After your bandage and stitches are removed, you may notice some sensitivity of the scar. This is quite common and will settle with time. Don t be afraid of touching your scar as this is the best approach to reducing the sensitivity. Massaging the scar with non scented cream (e.g. E45 cream) for 2-5 minutes twice daily will also help. You can start to use your hand for light activities from 48 hours after your surgery providing that these activities are comfortable and you don t get your bandages or wound wet. Often, the sooner you start to use your hand, the sooner your swelling and stiffness will settle. You can normally return to driving once your wound is healed and you are free of the bulky dressing. You must feel comfortable that you have enough movement and grip to be safe before driving. This should be between 5-10 days as a guide. It is worthwhile informing your insurance company of your surgery too. Manual workers can normally return to work around 6 weeks following surgery and office workers between 1-4 weeks dependent on how you feel. Exercises are important following your surgery in order to reduce swelling, maintain wrist and finger movements and to stretch the scar tissue and prevent this from tightening. Complete the following exercises approximately 10 times each, 4 times a day for at least the first 2 weeks after surgery.

5 Page 5 of 6 Make a full fist and hold for 3 seconds then straighten your fingers out as much as possible. Keep your fingers straight and bend your wrist forwards then backwards as far as is comfortable. Stretch your thumb away from your fingers and circle it around. Use your other hand to stretch your thumb outwards. Hold this at the point where it feels uncomfortable for 10 sec. Why nurse led service? Reduction in waiting times. Streamlined service. Open access service. Treatment by specialist trained nurses. Treatment and care that you deserve. Contact us Louize - Nurse Clinician: Tel: Bleep 1476 (not 24 Hour Service) (Monday, Thursday, Friday) Specialist Hand Therapy Team (Mon Fri, ) nlcts@stockport.nhs.uk If you feel that the service you have received could be improved please be sure to inform a member of staff with your suggestions.

6 Page 6 of 6 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number TO10 Publication date September 2013 Review date September 2015 Department Trauma and Orthopaedics Location Stepping Hill Hospital