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follow-up treatment

For how long do the sutures remains after the surgery of a carpal tunnel syndrome?

The sutures are usually removed after 12-14 days after the surgery of a carpal tunnel syndrome (CTS). The removal of the usually 5-7 sutures after open splitting is not painful.

With a good outcome of the procedure – as shown in the illustration – it should be almost possible to fully close the fist at that point of time.

How long does the wrist has to remain immobilized after the surgery of a carpal tunnel syndrome?

Every surgeon has a different approach. The immobilization can vary between 1-2 days and 1 week.The supporters of an immobilization argue that the wound has more rest in the first days and heals better and that the pain is less directly after the surgery. Some surgeons do not even immobilize the wrist.

The physician will take a decision on the duration of the immobilization based on each individual case.

How does the immobilization take place?

The immobilization is taking place with a splint. The splint has to be fitted in a ways, that the finger joints and the thumb can be moved easily.

Please be aware:

Every splint or bandage that constricts endangers the success of the surgery.

Immediatly contact the attending ohysician or the surgeon! Please never accept a bandage that restricts the fingers’ movement!

How ofthen should the bandage (splint) be changed?

With normal healing of the wound, I change the bandage 2, max. 3 times a week during the first 2 weeks for inspection.

Should drugs be taken during the follow-up care after an surgical treatment of the carpal tunnel syndrome?

With swellings and pain, an anti-rheumatism drug like Voltaren®, Ibubrofen®, Arcoxia®, or similar should be considered in addition to the (temporary) immobilization. I never recommend to take those drugs without consulting the family doctor, as they a large variety of side effects. (e.g. risk of getting a stomach ulcer).

The pain after the surgery usually respond very good on a treatment with regular painkillers like Novalgin® or Paracetamol®.

What can one do, if not only the surgical scar, but the whole area around the scar hurts after the surgery?

The illustration on the left shows such a – not rare – situation after the surgery of a carpal tunnel syndrome. The scar is slightly reddened and a little thickened. The arrows point on the are of the painful swelling. Especially if pressure is applied orloading, the whole surgical area hurts.

Sometimes this occurs due to early loading or rough exercise treatments.

A reduction of loading helps in milder cases. In case of longer lasting swellings after the surgery, the treatment with a cold laser can be tried.

Is a loss in sensitivity in the area of the scar normal?

Many patients report different skin sensations in the surgery scar or around the surgery scar. Sometimes also at the thumb ball. This symptom occurs due to irritations of a skin nerve, which runs through the area of a surgery.

The loss of skin sensations disappears with the scar maturing. Usually this happens slowly after weeks or months.

Only if the skin nerve has been hurt during the surgery (see surgery risk), the “numb feeling” remains and additionally an electrcizing pain occurs (neuroma).

When can full load being applied on the hand after a surgery of a carpal tunnel syndrome?

The hand should slowly be lead to the regular, daily load after the surgery in a period of several weeks. If you are too harsh, the hand and the wrist will will hurt and start swelling.

The surgeon determines the exact moment, since when the hand can be used as usual.

Attention: full capability for strenuous sports activities (Tennis, Golf) is not reached until a few weeks more. Especially regarding this point, the responsible surgeon must be asked!

Is physiotherapy necessary during the aftercare?

This differs from person to person. Many patients which underwent a surgery can use the hand well shortly after the removal of the threads. Every day life and work are the best “physiotherapy”.

I recommend this self-performing physiotherapy to be supported by frequent hand bathing in lukewarm water (5 x 5 Minutes a day) for about 6 weeks. 

It is also recommended to cream the surgical scar with an oily lotion several times daily.

A patient who’s movement range is behind expectations, should start early with physiotherapy.

What is important for the patient in regards to physiotherapy after the surgery of a carpal tunnel syndrome?

It is important that the hand never swells or hurts during the physiotherapy! A too intense exercise therapy is harmful and leads more to a severe movement disorder than to an improvemen!

If a physiotherapist is not taking care of the individual requirements of a patient, it is reasonable to switch to a new physiotherapist!

What needs to be considered during the follow-up treatment after the surgery of a carpal tunnel syndrome?

Please be aware of the fact, that scars on the hand are very sensitive for a long time and the end result of a surgical therapy is achieved after 6 month.

Which results are to be expected after the surgery of a carpal tunnel syndrome (CTS)?

The success of the surgery as well as of the conservative therapy are strongly dependent on the seriousness of the nerve compression.

As a rule of thumb: the longer the pressure was applied on the nerve and the older a person is, the poorer is the chance of curing all symptoms of the disease. Unfavorable factors are also diabetes mellitus or a polyneuropathy (inflammatory nerve disease)

If the surgical therapy is taking place at the right time, it is to be expected, that the agonizing night pain will be gone, as well as the disorder of the skin sensation. The pain also disappears after later surgeries of the CTS. The skin sensation does not always improve.