Hands & Feet

Your doctor has referred you to us because you may have symptoms of carpal tunnel syndrome (trapped nerve at the the wrist). When we see you there will be time for you to tell us about your problem and for us to examine you to find out what the problems are.

Sometimes it is necessary for us to arrange further tests (Xrays, blood tests or nerve conduction studies) to confirm the diagnosis and an operation may have to be postponed until the results are received. In most cases the diagnosis is straightforward and in some clinics we can proceed to offer you treatment immediately.

If you are on warfarin, clopidgogrel or dipyridamole (persantin) or any another anti-coagulant please contact our surgical team for further information prior to your operation.

Various options for treatment are available, not always surgical, ie:

1. If the symptoms are mild, a wrist splint may be recommended.

2. An injection of steroid around the nerve at the wrist is often useful for more symptomatic patients.

3. If the symptoms are severe, an operation is usually required.

• Please ensure you remove all your rings from the fingers and remove all forms of acrylic, painted, and false nails before your appointment and that you wear a loose sleeved top.

• Please also ensure your hands are thoroughly washed and clean and free from infection.

• The operation is done under local anaesthetic. This numbs the site and wears off after a few hours. The fingers may also go temporarily numb.

• The operation consists of dividing the ligament on the front of the wrist to relieve pressure on the nerve. The procedure takes about 45minutes.

• Please ensure you have someone to drive you home afterwards.

The hand can only return to normal when the ligament that was divided during the operation has reformed. This will take several weeks. During this phase the hand will feel sore and weak and although some of the symptoms will have been relieved, sensation in the fingers can take several months to improve and some pain and discomfort can persist for several weeks. Although this operation is thought of as a quick day-case procedure the recovery period can be prolonged but the long term results are generally good.

Once the stitches are removed we would encourage you to use the hand for all the day to day activities and to undertake finger and wrist stretching exercises. However heavy lifting and hard manual work should be avoided for about four weeks.

The scar will be raised and tender at first but will soften and fade with time. You can help this process by massaging the scar with E-45 cream or Vaseline: three or four times a day after the stitches have been removed.

You will probably need some time off work. The period depends on the type of work that you do. Heavy work may need 4-6 weeks. We can provide you with a sick note if you require an operation.

Any surgical procedure has an element of risk attached to it and occasionally things do not turn out as well as expected. Fortunately with carpal tunnel release the risks are small and the outcomes usually very good. (90-95%)

Failure to improve after surgery is about 5-10%.

Recurrence of symptoms after successful surgery is rare, reported rates vary from 1/200-1/500 and can occur from 6 months to 20 years after surgery. Recurrent symptoms can be treated by re-operation but the results are not predictably good. Serious infection is extremely rare, less than 1/1000, but you must take care to keep the dressings clean and dry. If you experience a lot of pain in the hand, swelling of the fingers, high fever or flu-like symptoms you should immediately seek advice. Minor, superficial infections may require antibiotics.

Damage to the nerve during the operation, causing numbness in the fingers or weakness of the thumb muscle is also extremely rare, less than 1/1000.

Scar tenderness can persist for several months but usually settles down in time.

Some who do are not progressing satisfactorily because of persistent post-op pain, stiffness or finger swelling may require physiotherapy but this is unusual.

A rare complication of injury to the hand including surgery is ‘chronic regional pain syndrome’ the hand is disproportionately painful and stiff with some swelling. You should seek advice promptly if you experience such symptoms. This can last for many months and is difficult to treat.

How do I care for the dressing?
Keep the dressing dry and intact until the stitches are removed.

Do I need to take pain killers?
If you have any pain or discomfort, take some pain killers such as paracetamol or Ibuprofen, providing you are not allergic to them. Please don’t take Aspirin or any medication containing Aspirin, e.g. Dispirin, as these can cause bleeding.

We also recommend taking vitamin D for one month after surgery to help with healing and to reduce the risks of chronic reginal pain syndrome.

When do the stitches come out?
The stitches are removed after 10 to 12 days. Please make an appointment with your own Practice Nurse or with the Camborne & Redruth Hospital if you live in that area. (See details below):

Tel: 01209 318070 or 01209 318069 8am – 5pm Mon-Fri.

The hours of the clinic are: 8.45am – 1:30pm Mon – Fri.

9am – 11.30am Sat, Sun and Bank Holidays).

How long do I wear the sling for?
Wear the sling for at least 3 to 4 days or until you are comfortable without it. If you are sitting watching television or reading, you can take the sling off but you must put your hand up on pillows or cushions so that it is higher than your elbow.

What do I do at night?
Either keep your arm in the sling and sleep semi-upright or take it out of the sling and support it on pillows. Once again, the hand must be higher than the elbow.

Do I need to do exercises?
Start doing finger exercises at least every hour after your operation. Bend and stretch the fingers but don’t bend the wrist. The exercises help to reduce any swelling and stiffness. Intermittently, take the arm out of the sling and move the shoulder around. Bend and stretch the arm before putting it back in the sling.

What if my fingers become swollen?
The most important way of preventing swelling of the fingers is to keep them up either in the sling, elevated on pillows or keep the hand up on your chest.

If, after a few days, you have discarded the sling and the fingers swell, it could be because the hand is being left down. If this happens put it back in the sling or keep it up on your chest.

If you have a lot of swelling, please contact us so we can arrange for you to come and see one of our nurses. If you are unable to see us, you will need to see your Practice Nurse so she can take the dressing down, inspect the wound and re-bandage your hand.

When can I bath or shower?
You can bath or shower the evening after your operation. It is most important to keep the dressings dry. Put a plastic bag over the operated hand or wrap it in cling film and keep it well out of the bath/shower area as much as possible.

What problems should I look out for?
If you have a lot of pain, swelling of the fingers and a possible temperature, you may have an infection. Contact us as soon as possible. If it is out of hours, contact Urgent Care Services on NHS 111.

If you have bleeding coming through the bandaging, apply pressure for 30 minutes and contact us as soon as possible. If it is out of hours, contact Urgent Care Services on NHS 111.

Please contact us in the first instance, rather than your own surgery, on 01726 885104 if you have any queries or problems. Phone lines are open Monday to Friday 08:30am – 4:30pm only.

If outside of these hours, then please contact Urgent Care Services on NHS 111.

Your doctor has referred you to us because you may have symptoms of ulnar nerve compression. When we see you there will be time for you to tell us about your problem and for us to examine you to find out what the problems are.

Sometimes it is necessary for us to arrange further tests (X-rays, nerve conduction studies, blood tests) to confirm the diagnosis and an operation may be postponed until the results are received.

Nerve compression at the elbow is the second most common nerve entrapment after carpal tunnel syndrome in the hand.

It can cause symptoms in the little and ring fingers, patients can describe pins and needles, tingling in these two digits and weakness of the hand. If left unattended it can cause numbness and weakness of small muscles of the hand that will be very difficult to recover, in many cases impossible.

If you are on clopidogrel, dipyridamole (persantin) or warfarin please contact the surgery for further information - as soon as you receive this information leaflet.

It is unusual to have persistent symptoms after ulnar nerve decompression after recovering from the surgery. However, if there has been significant loss of function (weakness or numbness) from damaged nerves before surgery it can be a long time before the function returns to normal. In general recovery takes much longer than carpal tunnel, many cases more than a year.

Any surgical procedure has an element of risk attached to it and occasionally things do not turn out as well as expected.

Serious infection is extremely rare, less than 1/1000, but you must take care to keep the dressings clean and dry. If you experience a lot of pain in the arm, swelling of fingers, high fever like symptoms you should immediately seek advice. Minor superficial infections may require antibiotics.

Dressings - these are wool and crepe bandages which stay in place for 6 days until a wound review with a Probus Surgical Centre nurse or if you are unable to return to Probus with your own practice nurse. You will usually have dissolvable sutures which will disperse over 4-6 weeks. If you have sutures that need removing, we will inform you of this.

Exercises – gentle bending and straightening of your arm is advised as soon as the next day. Avoid any physical activity (swimming, cycling, running etc.) for two weeks. If you have a physical job the surgeon will recommend 2- 3 weeks off work.

Pain control – we recommend you take some pain killers such as paracetamol as soon as you get home and then regularly for the first 24-48hrs, following the instructions on the packet.

Where to get advice

If you have any concerns during the post-op period you can get advice or help from one these sources.

1. First contact one of the surgical team at Probus on 01726 885104;

2. Or Contact your local surgery;

3. Out of hours, contact the NHS ‘111’ number; or

4. The A and E department of your local hospital

Severe pain, excessive swelling or bandages that are too tight or bloody should prompt you to seek advice. Take this letter with you and insist that the dressings are removed and the wound inspected before redressing.

Treatment is indicated if the ganglion causes pain, interference with function or if there is uncertainty about diagnosis. The cyst can be aspirated using a wide bore needle after numbing the skin with some local anaesthetic. As much material as possible is drawn out and some steroid can be injected into the cysts acting like a hardening agent. The cure rated is about 80% (similar to an operation). If is becomes recurrent, you will be offered an operation. This is also done under local anaesthetic and may be combined with a tourniquet, (applied to the upper arm for upper arm limb ganglion). The procedure takes about 15-45 mins. The ganglion is excised and the wound closed with some stitches.

For upper arm limb ganglia, please ensure that you remove all rings from your fingers before your appointment and that you wear a loose sleeved top.

Please ensure that you have someone to drive you home afterwards.

If you are on clopidogrel or dipyridamole (persantin) or any another anti-coagulant, please inform your surgeon at your assessment.

How do I care for my wound?
Following surgery you will need to keep your dressing dry and intact. The dressing stays in place until you have the stitches removed in 10 days time.

Can I have a shower or bath?
You can shower or bath but you must cover the dressings with a plastic bag or cling film.

When do the stitches come out?
The stitches are removed after 10 to 12 days.

with your own Practice Nurse or with the Camborne & Redruth Hospital if you live in that area. (See details below):

Tel: 01209 318070 or 01209 318069 8am – 5pm Mon-Fri.

The hours of the clinic are: 8:45am – 1:30pm Mon – Fri.

9:00am – 11:30am Sat, Sun and Bank Holidays).

How long do I wear the sling for?
Wear the sling for 48 to 72 hours. This helps to reduce any swelling to the fingers. If it is comfortable then wear the sling at night, if not elevate the hand on pillows next to you with your hand higher than your elbow.

What if the ganglion has been removed from my foot?
Keep your foot elevated, for instance up on a stool or cushions on the sofa, for at least 48 hours. Wear comfortable loose shoes when necessary.

What exercises should I do?
Bend and stretch your fingers almost immediately after your operation. The wrist will be restricted by dressings until they are removed and the stitches taken out. For ganglions removed from the foot, move the ankle around in a circular motion and bend and stretch the toes.

Do I need to take pain killers?
If you have any pain or discomfort, take some pain killers such as Paracetamol, or Ibuprofen, providing you are not allergic to them. Please don’t take Aspirin or any medication containing Aspirin, e.g. Dispirin, as these can cause bleeding.

We also recommend taking vitamin D for one month after surgery to help with healing and to reduce the risks of chronic reginal pain syndrome.

What should I do if the wound starts to bleed?
Press firmly on the wound with a clean dressing or handkerchief. If the bleeding doesn’t stop, contact us immediately or if out of hours, contact NHS 111 for advice.

What does it mean if the wound is red, painful and is discharging?
The wound is probably infected. Please contact us immediately or if it’s out of hours, contact NHS 111.

When can I return to work?
You can return to work in 2 to 3 weeks time. Check with your surgeon if you have any queries.

Please contact us in the first instance, rather than your own surgery, on 01726 885104 if you have any queries or problems. Phone lines are open Monday to Friday 08:30am – 4:30pm only.

If outside of these hours, then please contact NHS 111 on 111. Please note that NHS 111 may refer you on elsewhere if necessary.

Any surgical procedure has an element of risk attached to it and occasionally things do not turn out as well as expected. Fortunately they are rare and seldom serious.

The ganglion may recur in 20% of the cases. The skin around the scar may be permanently numb after the operation. Wound infection is another possible complication.

A rare complication of injury to the hand, including surgery is “chronic regional pain syndrome”. The hand is disproportionately painful and stiff with some swelling. You should seek advice promptly if you experience such symptoms. This can last for many months and is difficult to treat.

What symptoms does it cause?
Usually bending the finger is normal but beyond a certain range of movement, the sufferer has difficulty straightening the bent finger. This often straightens suddenly and a ‘click’ may be felt. There may be some pain and sometimes a little lump can be felt at the point of obstruction. The digits most commonly affected are the ring and middle fingers and sometimes the thumb.

What are the causes?
The cause is usually unknown in adults. Sometimes it may be associated with certain medical conditions like diabetes, rheumatoid arthritis or gout.

Treatment
This may consist of simply keeping the finger straight with a splint and the use of oral anti-inflammatory drugs. The recurrence rate is high.

A steroid injected into the tendon sheath is usually successful for early disease with minimal functional impairment.

If triggering is severe and/or injection has failed, surgical release gives the best long term relief.

You will be seen and assessed and if you are offered an operation, the following information may be useful.

If you are on Warfarin, Clopidogrel or dipyridamole (persantin) or any another anti-coagulant, please inform the surgery at assessment.

The operation is done under local anaesthetic, this numbs the site and wears off after a few hours. The fingers may also go temporarily numb. A 2cm cut is made at the base of the affected finger in the palm. The thickened sheath is divided. You should then be able to move your finger freely and we are able to check this under direct vision. The wound is then closed with some absorbable stitches. The hand is then bandaged and rested in a sling to minimise swelling. The procedure takes about 15 minutes.

Please ensure that you remove all rings from your fingers before your appointment and that you wear a loose sleeved top. Also ensure that you have someone to drive you home afterwards.

How do I care for my wound?
You may remove bandages after two days. The wound must stay covered with an adhesive dressing until you have the stitches removed in 10 days time.

Can I have a shower or bath?
Yes, but you must cover the dressing with a plastic bag or cling film.

When do the stitches come out?
The stitches should be removed in 10 days time.

Please make an appointment with your own Practice Nurse or with the dressings clinic at Camborne & Redruth Hospital if you live in that area. Tel: 01209 318070 or 01209 318069.

How long do I wear the sling for?
Wear the sling for at least 48 hours. This helps to reduce any swelling to the fingers. If it is comfortable then wear the sling at night, if not elevate the hand on pillows next to you with your hand higher than your elbow.

What exercises do I do?
Gently bend and stretch your fingers including the one operated on, at least every hour.

Do I need to take pain killers?
If you have any pain or discomfort, take some painkillers such as Paracetamol or Ibuprofen, providing you are not allergic to them. Please don’t take Aspirin or any other medication containing Aspirin, e.g. Dispirin, as these can cause bleeding.

We also recommend taking vitamin D for one month after surgery to help with healing and to reduce the risks of chronic reginal pain syndrome.

What do I do if the wound starts to bleed?
Press firmly on the wound with a clean dressing or handkerchief. If the bleeding doesn’t stop contact us or, if out of hours, contact NHS 111.

What does it mean if the wound is red, painful and is discharging?
The wound is probably infected. Contact us immediately for advice and treatment with antibiotics or, if out of hours, contact NHS 111.

When can I return to work?
You can return to work in 10 days time. Check with your surgeon if you have any queries.

Please contact us in the first instance, rather than your own surgery, on 01726 885104 if you have any queries or problems. Phone lines are open Monday to Friday 08:30am – 4:30pm only.

If outside of these hours, then please contact NHS 111 on 111. Please note that NHS 111 may refer you on elsewhere if necessary.