The following are post-operative instructions for patients who have undergone carpal tunnel release of their wrist. Please refer to this reference sheet, which should probably answer most of the questions you might have. If you have further questions that need immediate answering, contact our office at (970) 879-4612 or 877-404-4612.
You will have a bulky dressing and splint. Although it is very unlikely, you may notice some bloody spotting coming through the outer Ace wrap. It is important for you to watch this area, and contact us if it continues to spread. Otherwise, any small area of spotting will dry and can be ignored until you remove the dressings.
The suture utilized in closing the wound is nonabsorbable. The sutures will need to be removed. Usually, we removed the sutures when you follow-up in the office. This can occur as early as seven days but usually 10-14 days after surgery.
Elevation and Ice
Elevation will help minimize the pain and swelling after surgery, especially during the first few days. Elevation, to be effective, involves keeping your wrist above the level of your heart. You can keep ice packs on the palmar side of the splint continually during the first few days without risk of frostbite injury to the underlying skin as long as the original dressings are in place. I feel that elevation is more important than icing due to the thickness of the splint and dressings.
You can remove your dressings to shower 3-5 days following surgery (i.e., surgery on Thursday, shower on Sunday, Monday or Tuesday). Remove the dressings to the sutures, shower, allow the wound to dry. Apply a light gauze dressing or large Band-Aid. You can continue to use the splint or any wrist splint or Ace wrap. How much protection you use is usually dictated by your comfort level. If you’re more comfortable leaving the original dressing on that is okay. Simply keep the splint and dressing from getting wet during showering by elevating your arm. If there is any noticeable or persistent drainage from the incision site or any surrounding red areas, please contact us immediately.
In general, the recovery from carpal tunnel release is rapid and can be accomplished with home exercises and Theraputty for strengthening. If you prefer a prescription for formal therapy can be written so please let me know.
USE OF THE HAND:
Unless instructed otherwise, we encourage you to increase motion of your fingers as soon as possible, within your comfort range. You can use the hand for routine activities. I do not want you to do any heavy lifting, pushing or pulling until the wound heals.
Please call our office within a few days following surgery to schedule your first follow-up visit for 10-14 days after surgery unless instructed otherwise after surgery.
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually, we will prescribe hydrocodone, hydromorphone, or oxycodone. These are generic names for three different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery.
You might also be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual maximum adult prescription dosage is 600-800 mg three times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid taking these medications. If you have high blood pressure you should check your blood pressure to be sure these medications do not cause an elevation in your pressure. If you have kidney problems you should avoid these medications.
Plain Tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg. If your narcotic pain medicine is not lasting long enough you can use a little more or use if less often as long as you do not overuse the maximum daily acetaminophen dose.
If you have a history of nausea with surgery we can prescribe an antinausea medication (Phenergan or Zofran). Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.
Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I cannot provide prescription refills after business hours or on weekends.
Carpal tunnel release surgery is a fairly simple and minimally invasive outpatient surgery, so postoperative complications are fortunately quite rare. The incidence of an infection deep within the hand is literally one out of thousands. The onset of symptoms would be approximately 5-7 days following surgery, and would consist of a significant increase in pain, swelling, warmth, and redness of the hand, wrist, or forearm, fever, chills or night sweats. More common, but still quite rare, would be a small superficial infection or irritation at the skin incision. Contact our office for any concerns at 970-879-4612 or 877-404-4612.
Bryan Bomberg, MD