Hand Surgery Sydney

• Performed under Sedation and local anaesthetic, or General anaesthetic in a hospital setting
• The surgery is quick and often takes 15 minutes of surgery time.
• Patients are in hospital for the day only.
• Medicare/Health fund rebate: Yes which covers all the hospital costs of surgery and part of the surgical and anaesthetic fee.

• Is performed under tourniquet control
• A small Longitudinal incision is made in the palm
• Dissection is carried down to the carpal tunnel and the ligament covering the contents of the tunnel (called the transverse carpal ligament) is cut under direct vision.
• The median nerve is freed over the entire tunnel
• The wound is then closed and dressings applied

• You may go home the same day or stay
• You will be sent home with a sling and adequate pain relief
• You will be seen at the 1 week mark for a wound check, and then at 2 weeks for removal of sutures.
• If needed you may be referred to a hand therapist for hand exercises.

• In general the surgery offers immediate results. Most patients report immediate relief of symptoms, however the improvement depends on how severely and for how long the nerve has been compressed. The more severe the compression the longer it takes for the nerve to recover.

Every surgery carries risks, and therefore one must consider if risks outweigh the benefits for your own personal situation. If they do then the surgery may be well worth it. Dr Aggarwal will discuss the pros and cons of surgery with you during your consultation.

General Complications

• Risks of anaesthetic – there are general risks of going under an anaesthetic such as a mild stress on the heart and lungs, risk of reaction to anaesthetic drugs and risk of clotting in the legs. These risks are generally low in patients who are otherwise fit and healthy.
• Bleeding (1-2%) – any bleeding is controlled during surgery and really only arises from the skin incisions. Most stops with hand elevation and compression.
• Infection (<1%) – this is very rare. However you are given antibiotics during induction (when you are going to sleep), as well as a course of oral antibiotics after your surgery to keep this risk to a minimum.

Specific Complications

• Slow improvement in symptoms – The median nerve recovers more slowly if it has been severely compressed for a long time. In some cases where permanent damage has already occurred, especially if carpal tunnel syndrome was so severe to cause weakness and muscle wasting, the nerve may not recover fully.
• Damage to the recurrent branch of the median nerve – there is a nerve that arises from the median nerve in the region of the carpal tunnel that supplies the muscles at the base of the thumb. These muscles assist in fine movements of the thumb. In most patients this nerve arises beyond the carpal tunnel and is not at risk during surgery. However in some patients there can be an anatomical abnormality and the nerve passes though the ligament covering the carpal tunnel and is at risk of injury. If injured this will cause weakness of the thumb movements, however the nerve is repaired and slow recovery would be expected.
• Pillar pain – Release of the transverse carpal ligament (the ligament covering the carpal tunnel) can cause pain on either side of the palm after surgery, called pillar pain. The pain probably occurs due to lack of the stabilising function of the ligament when it was intact. The pain eventually settles.

Do I need a referral for Carpal Tunnel Syndrome?

• Yes
• This allows you to claim a Medicare rebate of approximately $73 for the initial consultation, and to be eligible for rebates for surgery.

Where can I see Dr Aggarwal?

• You can see us at our main practice at Gordon, or at our other locations at Hornsby, Hunters Hill or Camperdown.
• Please scroll to the bottom of the page to find out more information about these locations.

Where will I have my operation?

• Any of the hospitals where Dr Aggarwal works – i.e. Sydney Adventist Hospital, SAN Day Surgery, or Hunters Hill Private hospital.

What can I do to prepare for surgery?

• Cease fish oil, and other supplements such as Ginkgo, Ginseng.
• Please discuss with Dr Aggarwal if you are on blood thinning medications as to when you should stop and recommence those.
• If you are smoking you need to cease this well in advance of surgery.

After surgery, will I need to wear a special garment?

• You will bulky dressings on your hand for 1 week. You will have to keep these dry.
• These will be removed 1 week after surgery at which point you will be able to get your hand wet.
• If required you may need to see a hand therapist to guide you through exercises.

Will I be able to exercise after surgery?

• You should not do any exercise that raises your blood pressure for at least 72 hours after surgery
• You should not do any heavy lifting or work with the operated hand until the wound is fully healed and your movement, and sensation has recovered.

Will I need special medications after surgery?

• Dr Aggarwal will provide you with the necessary scripts for antibiotics and pain relief.

Will I need further surgery?

• Not usually.
• Many people have both hands affected and may choose to return for an operation on the other hand once the operated hand has healed.

Can I travel in an airplane after surgery?

• Yes
• However we always encourage patients not to be away overseas shortly after having a procedure, so that we can closely follow your recovery and address any concerns that may arise.

When will I be able to swim after Carpal tunnel release?

• You may swim in a pool or beach after all the wounds have healed. In general this takes at least 2-3 weeks but it can sometimes be longer.

When will I be able to drive after Carpal tunnel release?

• You should not do any driving for the first week.
• Thereafter it depends on how your wound is healing and how much stiffness, pain and residual symptoms you have.
• Your hand therapist will also guide you when you are ready for driving.

Are there any alternatives to surgery?

• Non-surgical options for Carpal Tunnel Syndrome including splinting especially at night.

• At Mode we follow the schedule of fees listed by the Australian Medical Association for this procedure.
  • For patients who are insured with funds that allow known gap (access gap) billing, we will usually utilise this and charge a $500 known gap. Please note that NIB does not allow known gap billing.
  • The rest of the surgical fee is claimed from Medicare and the health fund.
  • The anaesthetic fee will usually be a $250 known gap.
• Please note that the above pricing does not include
  • Preoperative consultation fees – which are $250 for the initial consult and $125 for additional preoperative consultations if needed.