Complications

All common surgical complications can also occur with carpal ligament splitting (carpal ligament splitting). These include bacterial infections, secondary bleeding, nerve injuries and others. Post-operative scarring, remaining bone spikes, re-inflammation of the tendon sheath or incomplete ligament splitting can lead to recurrence (carpal tunnel syndrome).

Unfortunately, even if the operation is successful and the surgical technique is correct, there is always the possibility that the disease, including nerve compression, may reoccur. This is especially the case if postoperatively a so-called “excessive scarring” occurs. From a medical point of view, this is called recurrent carpal tunnel syndrome.

In rare cases, a so-called recurrence makes a follow-up operation necessary, especially if remnants of the carpal roof are still intact and nerve compression is still present. Other causes of recurrence are strong growths of the tendon sheaths, e.g. in rheumatism/rheumatoid arthritis or dialysis patients, and the growth of a tumor in the carpal canal. A distinction is made between follow-up treatment with a plaster splint and without a plaster splint.

In cases in which the doctor decides on a plaster splint, it is applied directly after the operation. It must usually be worn for about a week and is changed frequently, especially in the first week. This constant changing is due to the fact that the wound healing as such must be under observation.

After one week of plaster splinting, a padded bandage is applied for another week. In both cases, care must be taken to ensure that the patient can move his fingers easily. The stitches from the operation are usually removed on the 14th postoperative day.

Since the operated hand is to be gradually brought closer to the daily strain, not all activities can be performed again immediately. If the hand is brought back to its normal position too quickly, pain occurs and the hand swells up. As a rule, in the first 6 weeks after the operation, the operated hand should be moved, but should not be subjected to any stress.

As a rule of thumb: Stress begins as soon as you lift something heavier than a cup of coffee! It has proven to be a good idea to rub the operated hand with a fatty cream several times a day during the first months.During the first 6 to 8 weeks, the hand should be bathed in lukewarm water three times a day for 5 minutes. In most cases, treatment by a physiotherapist is not necessary.

In most cases, the above mentioned exercises in the water bath are completely sufficient. Only if the patient feels that the mobility of his hand does not return in a reasonable time, he should contact the treating doctor. Together, an exercise therapy can then be considered.

The following should be observed in any case: Any kind of movement therapy – whether it is carried out independently or by the physiotherapist – must never cause pain. If you feel pain, always remember that pain during exercise therapy does not lead back to normal mobility faster, but rather slows down the healing process. In individual cases, the pain experienced during exercise therapy can even cause permanent movement deficits!

One week of plaster cast or immediate early functional movement therapy and beyond that no excessive wrist strain for 6-8 weeks. The suture material is removed after about 10 days. Incapacity to work can exist for 3-8 weeks – depending on occupational stress and healing process.

Due to the hormonal changes, a pregnant woman stores more fluid, especially in the last third of the pregnancy, which can also cause an increased fluid content in the carpal canal. If this carpal canal is already quite narrow due to its individual shape, the increased fluid content results in increased pressure on the median nerve. This results in pain in one or both hands, which can also radiate into the whole arm.

This pain occurs especially at night. Basically, thanks to modern anaesthesia methods (e.g. plexus anaesthesia = isolated anaesthesia of the arm) the risk for mother and child is acceptable and therefore even a pregnant woman with carpal tunnel syndrome can be operated on. This is especially true if the operation is performed in the last third of the pregnancy and the hand surgeon and gynaecologist cooperate closely.

Every expectant mother who has carpal tunnel syndrome should ask herself the crucial question, together with the hand surgeon treating her, whether such an operation should be performed during pregnancy, while consulting the opinion of the gynecologist (specialist in gynecology). Every expectant mother should take into account that such an operation can be performed in the case of extremely distressing symptoms and – even in the respective situation – can be quite useful. On the other hand, however, every affected woman should also know that after delivery (and possibly while breast-feeding), due to the reduction of the body’s own water content, many carpal tunnel syndromes subside completely without therapy, especially if the pain first appeared during pregnancy.

Several scientific causes have clearly proven this. Once a young mother has breastfed the baby, surgery can be performed at any time. When planning the operation, however, it must be taken into account that postoperatively large parts of the baby care cannot be carried out by the mother herself.

It must be taken into account that in the first 2-3 weeks, especially diaper changing and bathing the baby must be done by someone else. This is explained by the fact that even if the wound is sutured and additionally protected by a bandage, it can be infected by bacteria from the diapers used. If bacteria get into the wound, it is very likely that an infection will be triggered which will have a negative effect on healing.