Dr.

Kutnik Postoperative Protocol

Carpal Tunnel Release
Day of Surgery
Cast - You will have a cast on your wrist to protect the incision. Your fingers will be
free. The cast needs to remain dry at all times. When showering, cover it with a
plastic bag secured with tape to keep out the water (medical or duct tape works
best). Men may want to shave around your forearm at this level to save some
additional pain from the tape. If your cast gets wet, it will quickly lose its integrity
and may put your wound at risk for infection.
Elevation - You should elevate your arm at all practical times. It should be kept
above chest (heart) level. At night, prop it up on pillows for this purpose. This is the
most important thing to keep swelling down and will greatly assist with pain relief.
Anesthetic - In most cases, I will have injected your hand with local anesthetic for
the procedure. This will usually last 12 hours but may range from as little as 6 to as
long as 24. As it wears off, sensation (including pain) will return. Your fingers should
move freely immediately after surgery.
Pain Medication - You should start taking your pain medication as soon as you begin
to experience any pain/discomfort to your hand which suggests the anesthetic is
starting to wear off. If your hand is still numb prior to going to sleep, it is advisable
to take a pain pill anyway as it may wear off overnight. Keep ahead of your pain for
the first 48 hours by taking the medication as scheduled if you are having any
symptoms. If you wait until it is extremely severe, the pills are unlikely to keep up
with your pain.
Antibiotic You received an antibiotic just prior to your procedure. I do not routinely
prescribe any postoperatively for this procedure.
Activity Early motion of your elbow and fingers is encouraged and critical.
You may use the arm for light activity only. This means using a fork, typing, etc No
lifting or gripping. Your goal is to keep your fingers mobile to prevent stiffness and
decrease swelling. Do not worry about strengthening, it will return with time once
you are healed.
First Postoperative Visit (10-14 days postop)
Your cast will be removed in the clinic. Your incision will be checked and
sutures removed at this time. My expectation is that you should have full motion of
your hand/fingers. I will instruct you on beginning scar massage to desensitize your
wound and improve its final appearance. There is no need for antibiotic ointment.
Vitamin E lotion may help improve your scar but should be used sparingly (i.e. do
not keep the wound wet with lotion). You may begin using the hand as tolerated but
remember that full healing occurs over a matter of months. Some residual soreness
with use is common. Excessive lifting or strenuous activity will likely cause pain and
may prolong your recovery.
Week 5-8

I will recheck you around this time to see how youre doing. You can return to
full activities with no restrictions assuming no concerns are present.

EXPECTATIONS:
Most patients will experience almost immediate relief of nighttime symptoms
if they were present preoperatively. Persistent numbness during the day and with
use is common and will likely improve over a matter of months. While complete
relief may not always occur, numbness should not be worsening following the
surgery and during recovery. If you had muscle weakness or atrophy prior to
surgery, improvement is less predictable, but again, should not be worsening. A
common complaint postoperatively is soreness on either side of the incision (this is
called pillar pain). Its cause is unknown but if it does occur, it typically will last for
up to six weeks but then resolve. Expect full recovery to be on the order of 3
months after your surgery.
GENERAL INSTRUCTIONS:
Feel free to contact my office at any time with questions/concerns (314-8490311 x191). Although you may have good days and bad, your hand should on the
whole slowly improve in terms of pain/function throughout this process. If at any
time you experience a sudden change in progress or pain, contact my office
immediately. If you experience fevers/chills, redness or drainage from your wound,
call my office.