At the front of the wrist is a tight tunnel, the carpal tunnel, through which the flexor tendons (8 to the fingers and one to the thumb) and the median nerve pass into the hand. The floor of this tunnel is made by the wrist bones and the roof is made by a tough ligament (the transverse carpal ligament).
Carpal tunnel syndrome (CTS) is when the median nerve is compressed in the tunnel. The median nerve supplies some of the muscles that work the thumb, as well as sensation to the thumb, index, middle and half of the ring fingers.
Symptoms of CTS are typically pins and needles and tingling or numbness in the above 2 ½ fingers and thumb. There may be discomfort and pain in the hand which may also radiate up the forearm. There may also be weakness of the thumb that may interfere with hand function. Often patients complain of waking up at nights with these symptoms and need to shake their hands to get relief. In its most severe form, the muscle at the base of the thumb may even be wasted.
Mild carpal tunnel syndrome is usually managed by non-surgical means initially. Some of these include splinting to rest the wrist to stop it from bending especially at night. Others include weight loss, fluid loss, activity modification and steroid injection into the carpal tunnel.
Moderate to severe CTS usually requires surgery (carpal tunnel release) to decompress the carpal tunnel and relieve the pressure on the median nerve. This is done by dividing the tough ligament that forms the roof of the carpal tunnel (the transverse carpal ligament) and creating more space in the tunnel.
Hand surgery is one of Dr Safvat’s interests and areas of expertise. Carpal tunnel release (CTR) can be done as an open operation or with a telescope (endoscopically). Dr Safvat has been trained and has experience in both methods but prefers to do it via an open method as the very small benefits of the endoscopic procedure are not worth the increased risks of complications associated with it.
Carpal Tunnel Release is performed in an accredited Sydney hospital, usually under a short general anaesthetic but can also be done under local anaesthetic in some cases.
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The procedure is done as a day only procedure without the need to stay overnight in hospital. The hand and wrist are usually wrapped in a bulky bandage and patients are discharged with a sling to elevate their hand. Finger movement is possible after carpal tunnel release surgery but wrist movement is usually restricted. The dressing needs to stay dry and intact for one week when Dr Safvat will remove them in Ethique Plastic Surgery’s private rooms in Miranda, Bowral or Concord. He will then give his patients exercises to do after this time. The sutures are dissolvable and will fall out by themselves with some scar massage.
Dr Safvat will give his patients exercises to do starting one week after surgery.
Carpal Tunnel Release surgery does not cure everyone. There is about 10% chance of not improving after the surgery. This is often the result of wrong diagnosis. Dr Safvat insists that all his patients have a nerve conduction study before the operation. This not only confirms the diagnosis but can also be used as an objective measurement to gauge Median nerve recovery after the carpal tunnel release procedure.
Patients must also be in good overall health and should stop smoking 3 weeks prior to the surgery.
There is no way to prevent scars completely after surgery and everyone can scar differently. However, the techniques Dr Safvat uses to suture his wounds are designed to minimise scarring. What’s more, any scarring will fade over time, especially if they are cared for correctly.
Dr Safvat will provide you with his specific protocol for scar management that will help you protect and care for your incisions in a way that will minimise scarring. Patients who have followed Dr Safvat’s protocol for scar management diligently have been very pleased with their progress in reducing and fading of scars.
Dr Safvat will provide you with his specific protocol for scar management that will help you protect and care for your incisions in a way that will minimise scarring.
Whilst it is possible to operate on both hands at once, it is not practical from a recovery perspective as both hands will be out of action for several weeks.
While all care and diligence is taken by Dr Safvat to minimise or avoid complications, any surgical procedure can be associated with some general complications and/or specific complications related to the surgery you are having. Choosing a Specialist Plastic Surgeon such as Dr Safvat and having your procedure done in an accredited hospital minimises risks as does using an accredited Anaesthetist. Some general surgical potential complications are:
Specific complications:
Carpal Tunnel Release has a Medicare item number and patients should get a rebate from Medicare and their health fund (where applicable). The hospital costs are usually covered by private health funds depending on the patient’s level and type of coverage. Alternatively, you can have the procedure done in a Private Hospital as a Self-Funded patient. Detailed information regarding costs will be provided to you after your consultation.
Renowned for his dedication to his patients, his attention to detail and impeccable outcomes, Dr Safvat's unparalleled expertise is reflected in the quality, professionalism and dedication of every member of our team.Â
