Carpal tunnel release surgery

About carpal tunnel release surgery

Your GP will usually only recommend that you have surgery for carpal tunnel syndrome if you have moderate to severe symptoms. For example, you may have had tingling, numbness and pain in your hand and forearm that has lasted for six months or longer.

The most common type of surgery is open carpal tunnel decompression. Another type of surgery that is performed by some surgeons is keyhole (endoscopic) carpal tunnel decompression. Your surgeon will discuss which technique is suitable for you.

In both types of surgery, your surgeon will cut the carpal ligament, which is one of the tissues that connect the bones in your wrist together. This will reduce pressure on the median nerve, which runs through your wrist to your hand. If the operation is successful, your symptoms of pain will often go away immediately after surgery, but symptoms of numbness and tingling may take longer to improve as the nerve recovers more slowly.

What are the alternatives to carpal tunnel release surgery?

If you have mild symptoms, or only had symptoms for a short time, your doctor will usually recommend that you have non-surgical treatment. If you get carpal tunnel syndrome during the later stages of pregnancy, you will also be advised to have non-surgical treatment. Treatment options include the following.

  • Wrist splints can help keep your wrist straight and reduce pressure on the median nerve. You wear these at night.
  • Hand therapy or physiotherapy, which will include exercises and making changes to your posture, particularly when working at a desk and using a keyboard, may help. Speak to your HR or occupational health department for more information.
  • Steroid joint injections are a good treatment if you have mild to moderate symptoms, or if you have only had symptoms for a short time. Steroid injections work by reducing inflammation around the nerve, which reduces the pressure on it.

If your condition is severe and your GP has referred you for surgery, this is usually after you have tried alternative treatments and they haven’t worked. Surgery is considered a last resort.

Preparing for carpal tunnel release surgery

Your surgeon will explain how to prepare for your carpel tunnel release surgery.

Carpel tunnel release surgery is routinely done as a day-case procedure. This means you have the procedure and go home the same day. It’s usually done under local anaesthesia. This completely blocks pain from your wrist and palm and you will stay awake during the procedure.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed so that you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during carpal tunnel release surgery?

In the operating room, your surgeon will ask you to sit in a chair, or lie down, and rest your arm out to the side. He or she will apply tight compression with a tourniquet to your upper arm. A tourniquet is similar to a cuff or small sleeve that is used to control blood flow to your hand during the operation.

Your surgeon will inject a local anaesthetic into your wrist and into the palm of your hand. You may feel a sharp sensation as the anaesthetic is injected, but this should pass quickly.

The exact procedure will then depend on whether you’re having open or keyhole surgery. Both types usually take about 20 minutes to complete.

Open carpal tunnel release surgery

In open surgery, your surgeon will make a single cut (3 to 4cm long) near the base of your palm. He or she will then divide the carpal ligament to relieve pressure on the median nerve. Your surgeon will close the cut in your skin with stitches.

How open carpal tunnel surgery is carried out

         

Keyhole carpal tunnel release surgery

Depending on the technique your surgeon uses, he or she will make either one or two small cuts (about 1 to 2cm long) in your skin. The first cut will be on the inside of your wrist and the second (if you have one) will be in the palm of your hand. Your surgeon will insert small instruments and a tube-like telescopic camera through the cut, or cuts. He or she will then divide the carpal ligament to relieve pressure on the median nerve. Your surgeon will close the cuts in your skin with stitches.

How keyhole carpal tunnel surgery is carried out

         

What to expect afterwards

After your surgery, it’s important to lift your hand above your heart and move your fingers – this will help to reduce swelling and will prevent stiffness.

After a local anaesthetic, it may take several hours before the feeling comes back into your wrist and hand. Take special care not to bump or knock the area.

You may need pain relief to help with any discomfort as the anaesthetic wears off. You will usually be able to go home when you feel ready.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

The length of time your stitches will take to disappear depends on what type you have. However, for this procedure, dissolvable stitches should usually disappear in about seven to 10 days and non-dissolvable stitches will be removed 10 to 14 days after your surgery.

Your surgeon may ask you to wear a wrist splint and sling after the procedure.

Recovering from carpal tunnel release surgery

It usually takes about eight weeks to make a full recovery from carpal tunnel release surgery, but this varies between individuals, so it’s important to follow your surgeon's advice. It may take several months for the strength in your hand and wrist to return to normal.

Ask your surgeon when you can return to your normal activities. You should be able to drive and do activities that involve light lifting and gripping soon after your operation. Your surgeon will advise you when you can return to work and if there should be any restrictions on your work activities. If you return to work and have a job that involves repetitive movements, it’s important to take regular breaks.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You may see a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) who may give you some gentle exercises to do to help reduce stiffness in your hand and get the strength back in your wrist.

What are the risks?

As with every procedure, there are some risks associated with carpal tunnel release surgery. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. For carpal tunnel release surgery, these may include:

  • pain and discomfort in your wrist and hand
  • a scar – this may be tender

Complications

Complications are when problems occur during or after the procedure. Complications of carpal tunnel release surgery include:

  • infection – you may need to take antibiotics to treat this
  • damage to nerves, blood vessels or tendons in your wrist. This may require further surgery to repair the damage
  • loss of strength and stiffness when pinching or gripping objects – this is usually temporary and improves as your wrist heals
  • continuing pain at the site of the scar and numbness – sometimes it can take several months for the discomfort to disappear completely
  • reoccurrence – it’s possible that the symptoms of carpal tunnel syndrome may return

If you’re having a keyhole procedure, it’s possible your surgeon may need to convert to open surgery if there are any complications.

Does open surgery or keyhole surgery give better results for relieving carpal tunnel syndrome?

Answer

Open and keyhole surgery are both as good as one another at reducing the pain and symptoms associated with carpal tunnel syndrome. The technique your surgeon will use will mainly depend on what he or she believes is suitable for you.

Explanation

There are no significant advantages of having one type of carpal tunnel release surgery over the other. Your scar will be slightly longer if you have open surgery. The risk of nerve injury may be higher with the keyhole technique. The surgery you have will depend on your surgeon’s advice and, where possible, your personal preference. Speak to your surgeon for more information.

Can I have carpal tunnel release surgery if I’m pregnant?

Answer

Although carpal tunnel release surgery is safe to perform during pregnancy, it's best to delay this until after you have given birth. This is because pregnancy-related carpal tunnel symptoms can often improve and go away after you have had your baby. You could also try other treatments, such as wrist splints or steroid injections, as these often work.

Explanation

During pregnancy, the fluid balance in your body can change and lead to swelling in your wrists. This can put pressure on the median nerve that causes the symptoms of carpal tunnel syndrome. Symptoms are usually most noticeable in the third trimester (28 to 40 weeks of pregnancy) and for most women, improve spontaneously after the birth of their child. For this reason, surgery isn't usually recommended during pregnancy.

Your GP may suggest wearing a wrist splint at night or having steroid injections into your carpal tunnel. Speak to your GP for more information.

What are good exercises to do after having carpal tunnel release surgery?

Answer

Gentle stretching exercises, such as straightening and bending your fingers into your palm to make a fist, or gently squeezing a foam ball, can help reduce stiffness in your wrist.

Explanation

After carpal tunnel release surgery you will have some pain and swelling in your wrist. Also, your wrist, fingers, elbow and shoulder may feel stiff for a few days. To help reduce stiffness and loosen your joints, your surgeon or physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) may advise you to try some gentle stretching exercises. Straightening and bending your fingers into your palm to make a fist, or gently squeezing a foam ball may be enough.

You may want to rest your hand for a day or two after surgery, before resuming light manual activities. You should be able to return to your usual activities soon after your surgery, but it’s important to follow your surgeon's advice. If your work involves typing or writing, build in regular short rest breaks and do some gentle stretching exercises. If you do any sporting activities that involve gripping or putting strain on your wrists, it may be best to wear a wrist and hand support that will protect your joints but check with your surgeon.

If you find it particularly difficult to use your hand normally after surgery, hand therapy may be helpful. Ask your surgeon or physiotherapist for more information.