The surgery can be done using a general anaesthetic (one that puts you to sleep) or a regional anaesthetic. A regional anaesthetic blocks the nerves going to only a portion of the body. Injection of medications similar to lidocaine are used to block the nerves for several hours. This type of anaesthesia could be an axillary block (only the arm is asleep) or a wrist block (only the hand is asleep). The surgery can also be performed by simply injecting local anaesthetic around the area of the incision.
Once you have anaesthesia, your surgeon will make sure the skin of your palm is free of infection by cleaning the skin with a germ killing solution.
A small incision is made in the palm of the hand over the spot where the nerve goes through the canal. The incision makes it possible for the surgeon to see the ligament that crosses over the top of the ulnar nerve. This ligament forms the roof over the top of Guyon's canal. Once in view, this ligament is released. Care is taken to make sure that the ulnar nerve is out of the way and protected. By cutting the ligament, pressure is taken off the ulnar nerve. Upon releasing the ligament, the surgeon sutures just the skin together and leaves the loose ends of the ligament separated. The loose ends are left apart to keep pressure off the ulnar nerve. Eventually, the gap between the two ends of the ligament fills in with scar tissue.
This surgery can usually be done as a day case procedure, meaning you can leave the hospital the same day.
Your hand will be wrapped in a bulky dressing following surgery. Take time during the day to support your arm with your hand elevated above the level of your heart. You are encouraged to move your fingers and thumb occasionally during the day. Keep the dressing on your hand until you return to the surgeon. Avoid getting the stitches wet. Your stitches will be removed ten to fourteen days after surgery.
Pain and numbness generally begin to improve after surgery, but you may have tenderness in the area of the incision for several months.
You will probably be referred for physiotherapy sessions for six to eight weeks, and you should expect full recovery to take several months. You will begin doing active hand movements and range-of-motion exercises.
When the stitches are removed, you may start carefully strengthening your hand by squeezing and stretching special putty. As you progress, your hand therapist will give you exercises to help strengthen and stabilise the muscles and joints in the hand.