Surgery in Primary Care (SIPC) for CTS
Most surgery for CTS in patients being treated under the East Kent CTS pathway is carried out in three GP surgeries in Faversham, Ashford and Herne Bay. We used to hand a out a paper information sheet about surgery at the time it is booked but the contents of that sheet are reproduced here and for patients who can access the internet it now seems better to save paper and direct them here.
The unit you are attending is specifically designed for people having operations which do not require admission to hospital. The staff will do their best to ensure that your visit is as comfortable and stress free as possible. Please read this information sheet carefully as it should address many queries which you may have and also contains a few specific instructions. If any other information is required or you need to change your appointment, please phone the administrative office in Ashford - 01233 667884 / 667885
One to two weeks before surgery you will have an appointment with the surgeon who will be performing your operation at the minor surgery unit. This will allow you to get to know the surroundings, and to discuss the procedure with the surgeon. You will be asked to sign a consent form for surgery and your medical details will be checked again, including measurement of your blood pressure. Occasionally we may do this pre-perative assessment on the same day as surgery.
BEFORE THE DAY OF YOUR OPERATION
Check that you have some mild painkillers at home (eg Paracetamol). If you wear rings, check that they can be removed easily, if not then visit a jeweller and get them removed or adjusted
ON THE DAY OF YOUR OPERATION
DO NOT drive yourself to the unit, you will not be able to drive after the operation because of the dressings on the hand
Please bath or shower before coming into the unit
Please do not wear make up or nail polish and REMOVE ALL RINGS AND JEWELLERY from the fingers, wrists and arms
Wear loose garments above the waist as you may not be able to get tight sleeves off over the bulky dressings after surgery.
Continue with any regular medication which you may be taking. Bring any drugs, medicines and inhalers that you are used to taking with you
Please bring your appointment letter with you to the unit.
You may eat and drink normally before surgery as this will be performed under local anaesthetic.
UPON ARRIVAL AT THE UNIT
Please check in at the unit reception desk at or before the time stated on your letter
Your surgeon will speak to you again before the procedure, though you will have met him or her two weeks previously at the pre-operative assessment.
THE OPERATION ITSELF
In the operating room after making sure you are comfortable, your nurse will apply a tourniquet but first line the top of your arm with soft cotton wool to reduce any discomfort. Next local anaesthetic is injected at the site of your operation (this may be painful). This works within minutes and will cause the site in your palm to become numb such that the actual operation will be painless. The tourniquet is then inflated. (This stops any bleeding and gives the surgeon an excellent view.) The cuff around the top of your arm will feel similar to the sensation of having your blood pressure checked but will be tighter and may feel uncomfortable. The amount of time the cuff is inflated however is kept to a minimum and it is released as soon as possible. Similar again to a blood pressure check a pumping sensation will be felt on deflation. Your wound will then be closed with stitches.
Apart from the discomfort due to the injection and the tourniquet and usual post-operative pain, this operation like any other carries certain risks. These include infection, bruising or haematoma formation (localised blood collection in the wound) and wound dehiscence (re-opening). A scar will occur and be permanent. A few patients develop hypersensitive skin around the scar and some a thickened scar and/or stiffness of the hand. In a very few patients hand stiffness can be severe and prolonged or even permanent (a condition known as algodystrophy). Physiotherapy may be needed and if so can lessen the risk of these complications. Unfortunately despite thorough assessment and a technically successful decompression of the median nerve a few patients still have an imperfect resolution of symptoms either because they are unlucky enough to have a trapped nerve in a higher position also or the nerve has been so damaged by pressure that it doesn't recover so another risk of the operation could be said to be 'continuation of symptoms'. However, to end on a less pessimistic note most patients do not fall into any of these categories and have a successful outcome!
AFTER THE PROCEDURE
You will be given instructions on care and use of the hand while the dressings are in place. If any problems arise before time for the stitches to be removed that have not been mentioned then please contact your own GP.
On returning home, expect to rest quietly for the remainder of the day with the hand elevated to help reduce swelling.
Take simple analgesics for pain. Keep the hand elevated in a sling for a few days afterwards.
Keep wiggling the fingers to help maintain the circulation. The hospital hand therapists recommend the following exercises to be done daily - starting on the day of surgery:
- Make a full fist and straighten your fingers out straight again.
- Touch your thumb to the tip of all your fingers.
- Spread your fingers out as far as possible and back again.
- Reach as high into the air as you can.
However, there seems to be no real evidence that this pattern of hand movements is superior to any other movements of the fingers in terms of speed of recovery or overall outcome.
The outer bandaging and cotton wool padding can be removed 72 hours after surgery unless you have been told otherwise by your surgeon but underneath you will see a white square skin dressing which should be left in place until you are seen for removal of the stitches.
Avoid getting the wound area wet.
We have already booked you a further appointment with the same surgeon, two weeks after surgery, for removal of the stitches.
Most patients are able to drive by between 10 and 20 days after surgery – depending primarily on how comfortable it feels to hold a steering wheel. Do not drive until you can manage a secure one handed grip for steering.
About three months after the operation we would like you to make one visit to your GP for an initial assessment of how well the operation has worked. We will write to you at this time with forms for both you and your GP to fill in and return to us. Please note that we send out these letters in batches and sometimes forget to do any of these for quite a few weeks so the interval until you get one of these letters can be quite long. They also do not get generated at all if the record of the operation is not made in the central records - something which has been difficult for some operations performed in Ashford.
Two or more years after surgery we may write or email to you to ask your final opinion on the outcome of the operation. You will either need to fill in a form and put it back in the post to us or visit this website. You can also record the success, or otherwise, of your operation on this website at any time. If you do add a follow up record to 'My CTS' then please also post a short note in the Canterbury patients forum (under Forums) to say that you have done so.
If at any time during this follow up period you develop further problems with the hand, your own GP can make arrangements for you to see one of the team involved in this programme for review. You can also report back directly to us via the website as we are always interested in any problems that follow carpal tunnel surgery, though we cannot guarantee a follow-up appointment.
Surgery will be performed at one of the following practices, your appointment letter will indicate which one. The following additional contact details may be useful
Faversham Medical Practice,
Faversham Health Centre
Beltinge and Reculver Surgery,
269 Reculver Road
St Stephen's Primary Care Health Centre
St Stephen's Walk