Carpal tunnel surgery on the Gold Coast
Assessment and treatment with Dr Daniel Williams, Specialist Plastic and Reconstructive Surgeon (FRACS).
A GP referral is required to be seen.
Understanding carpal tunnel syndrome
Numbness, tingling or pain in the hand that wakes you at night is one of the most common reasons people are referred for a hand assessment. It is often caused by carpal tunnel syndrome — pressure on the median nerve as it passes through the wrist.
Dr Daniel Williams is a Specialist Plastic and Reconstructive Surgeon (FRACS) with sub-specialty training in hand, wrist and microsurgery. He assesses and treats carpal tunnel syndrome at East Coast Plastic Surgery in Southport, on the Gold Coast.
Not everyone with carpal tunnel syndrome needs surgery. This page explains how the condition is diagnosed, what non-surgical options exist, and when carpal tunnel release may be considered.
What is carpal tunnel syndrome?
The carpal tunnel is a narrow passage on the palm side of the wrist, formed by the carpal bones and a band of ligament across the top. The median nerve and the tendons that bend your fingers pass through it.
When the space inside the tunnel is reduced, or the contents swell, pressure builds on the median nerve. That pressure interferes with the nerve’s ability to carry signals, which produces the numbness, tingling and pain that characterise the condition.
The median nerve supplies sensation to the thumb, index finger, middle finger and the thumb side of the ring finger. This is why symptoms typically affect those fingers and spare the little finger.
Symptoms
Common symptoms include:
- Numbness or tingling in the thumb, index, middle and part of the ring finger
- Symptoms that are worse at night and may wake you from sleep
- Pain in the hand or wrist, sometimes extending up the forearm
- A tendency to shake or flick the hand for relief
- Clumsiness, or dropping objects
- Difficulty with fine tasks such as buttons, keys or handwriting
- In longer-standing cases, weakness or wasting of the muscle at the base of the thumb
Symptoms often begin intermittently and become more constant over time. Numbness that is present all the time, or visible muscle wasting at the base of the thumb, suggests more advanced nerve compression and warrants prompt assessment.
What causes it?
In many cases no single cause is identified. Recognised contributing factors include:
- Repetitive or forceful hand and wrist use, including some occupational tasks
- Previous wrist fracture or injury that has altered the shape of the tunnel
- Inflammatory conditions such as rheumatoid arthritis
- Diabetes and thyroid conditions
- Fluid retention during pregnancy
- Family history and individual variation in the size of the carpal tunnel
Carpal tunnel syndrome can also arise following a work-related injury. Dr Williams manages both elective and trauma hand surgery, including WorkCover Queensland claims.
How carpal tunnel syndrome is diagnosed
Diagnosis begins with your history and a clinical examination. Dr Williams will ask about the pattern and timing of your symptoms, examine sensation and strength in the hand, and look for signs of muscle wasting.
Additional investigations may include:
Nerve conduction studies
These measure how well the median nerve is conducting signals across the wrist. They help confirm the diagnosis, indicate the degree of compression, and rule out other causes of hand numbness.
Imaging
Ultrasound or other imaging may be used in some cases, particularly where there is a suspected structural cause or a history of injury.
Part of the assessment is excluding other conditions that produce similar symptoms — nerve compression at the elbow or neck, peripheral neuropathy, or other causes of hand pain. Accurate diagnosis matters, because surgery on the wrist will not help symptoms arising from elsewhere.
Treatment and recovery
Non-surgical treatment
Where symptoms are mild or intermittent, non-surgical measures are usually considered first:
Night splinting. A splint holding the wrist in a neutral position during sleep can reduce pressure on the nerve overnight, when symptoms are often worst.
Activity modification. Adjusting how you perform aggravating tasks, and altering workstation or tool set-up where relevant.
Hand therapy. A hand therapist can advise on splinting, nerve gliding exercises and activity modification.
Corticosteroid injection. An injection into the carpal tunnel can reduce inflammation and relieve symptoms. Relief may be temporary, and a good response can help confirm the diagnosis.
Treating underlying conditions. Where diabetes, thyroid disease or an inflammatory condition is contributing, managing that condition may improve symptoms.
Carpal tunnel syndrome that develops in pregnancy often settles after delivery, and conservative management is usually preferred in that setting.
When surgery is considered
Carpal tunnel release may be discussed where:
- Symptoms persist despite non-surgical treatment
- Numbness is constant rather than intermittent
- Nerve conduction studies show significant compression
- There is weakness or wasting of the thumb muscles
- Symptoms are significantly affecting sleep, work or daily activities
Where nerve compression is advanced, surgery is generally considered sooner, because prolonged compression can cause changes to the nerve that do not fully reverse.
The aim of surgery is to relieve pressure on the nerve and prevent further deterioration. The extent to which sensation and strength recover depends on how long and how severely the nerve has been compressed.
Carpal tunnel release surgery
Carpal tunnel release involves dividing the transverse carpal ligament — the band across the front of the wrist — to enlarge the tunnel and take pressure off the median nerve.
Dr Williams performs open release through an incision in the palm, with sedation, as day surgery in a private hospital.
Recovery
Night-time symptoms often settle in the early weeks following surgery. Numbness that has been present for a long time may take longer to improve, and in some cases does not fully resolve.
You will be given specific instructions on wound care, hand use and return to activity. Hand therapy supports recovery of movement and strength, and helps you return to work and daily activities safely.
Tenderness around the scar and in the base of the palm is common in the early months and usually settles gradually.
Risks
Carpal tunnel release is a common procedure, but like all surgery it carries risks. These include:
- Incomplete relief of symptoms
- Persistent numbness where the nerve has been compressed for a long time
- Scar tenderness and discomfort at the base of the palm
- Temporary reduction in grip strength
- Infection
- Bleeding or bruising
- Injury to the nerve or nearby structures — uncommon
- Stiffness
- Recurrence of symptoms
- Complex regional pain syndrome — rare
Dr Williams will discuss the risks relevant to your situation, including any specific to your medical history, before you make a decision.
Revision and complex cases
Where symptoms persist or return after previous carpal tunnel surgery, further assessment is needed to establish why. Possible reasons include incomplete release of the ligament, scarring around the nerve, an alternative diagnosis, or nerve injury.
Revision surgery is more complex than a first procedure and may involve working directly on the nerve. Dr Williams completed sub-specialty fellowship training in hand, wrist and microsurgery at Piñal y Asociados (Madrid) and Clínica Cavadas (Valencia), Spain, and peripheral nerve surgery is one of his research interests.
Where nerve reconstruction or coverage is required, microsurgical techniques using an operating microscope may be used. Dr Williams accepts revision carpal tunnel referrals. A standard first-time carpal tunnel release is not a microsurgical procedure.
Work-related carpal tunnel syndrome
Where carpal tunnel syndrome is related to work, assessment and treatment can be managed under a WorkCover Queensland claim. Please bring your claim number and insurer details to your appointment, and let the rooms know when you book. The practice manages WorkCover claims directly.
Hand therapy
Hand therapy is planned as part of the treatment plan, whether or not surgery is involved, with the aim of a coordinated recovery and a return to work, sport and daily activity as your progress allows. Hand therapy at Southport is arranged through a partner practice.
About Dr Daniel Williams
Dr Daniel Williams is a Specialist Plastic and Reconstructive Surgeon, holding Fellowship of the Royal Australasian College of Surgeons in Plastic and Reconstructive Surgery — FRACS (Plast). AHPRA registration MED0001663694.
A Gold Coast local, he completed a Bachelor of Science at the University of Queensland and his medical degree at Griffith University, followed by five years as a junior surgical doctor and five years of accredited specialist training in Plastic and Reconstructive Surgery in Victoria and Queensland.
He completed sub-specialty fellowship training in hand, wrist and microsurgery at Piñal y Asociados (Madrid) and Clínica Cavadas (Valencia), Spain.
Appointments: Consultant Plastic and Reconstructive Surgeon, Gold Coast University Hospital; elective and trauma hand surgery, East Coast Plastic Surgery, Southport; Lecturer, Griffith University, teaching medical students for more than a decade.
Research interests: peripheral nerve surgery, wrist arthroscopy, reconstructive hand surgery, implant safety and patient-reported outcome measures.
Memberships: Royal Australasian College of Surgeons (RACS), Australian Society of Plastic Surgeons (ASPS), Australian Hand Surgery Society (AHSS).
Common questions
Do I need a referral?
Yes. A referral from your GP is required to be seen. It provides relevant medical background and allows Dr Williams to write back to your GP so your care stays coordinated.
Will I definitely need surgery?
No. Many people with carpal tunnel syndrome are managed without surgery, particularly where symptoms are mild or intermittent. Surgery is discussed when non-surgical measures have not resolved symptoms, or where nerve compression is significant.
What happens if I leave it?
Mild symptoms sometimes settle on their own, particularly where there is a temporary cause such as pregnancy. Where compression is significant and ongoing, however, it can lead to permanent changes to the nerve and to weakness of the thumb muscles. Assessment allows the degree of compression to be established.
Can carpal tunnel syndrome come back after surgery?
Recurrence is uncommon but possible. Where symptoms persist or return, further assessment is needed to establish the cause.
Can carpal tunnel syndrome affect both hands?
Carpal tunnel syndrome frequently affects both hands.
Where do I go?
East Coast Plastic Surgery, Suite 6, Level 5, 123 Nerang Street, Southport QLD 4215.
