Carpal tunnel release surgery

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who are having carpal tunnel release surgery, or who would like information about it.

Carpal tunnel release surgery is used to relieve severe symptoms of carpal tunnel syndrome, which causes pain or weakness in the hand and forearm. It involves cutting a ligament in the wrist to relieve pressure on a nerve.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About carpal tunnel release surgery

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

Carpal tunnel release surgery involves cutting 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.

The operation is usually done through a 3–4cm cut on the palm of the hand, near your wrist. Some surgeons use open surgery (where a single cut is made into your wrist to reach your carpal ligament) and others use a keyhole technique (where small instruments and a tube-like telescopic camera are inserted through small cuts in your wrist). Your surgeon will discuss the technique that he or she recommends.

Both open surgery and keyhole surgery are usually done on an out-patient basis, under local anaesthesia, which means you won’t need an overnight stay in hospital.

What are the alternatives?

For people with mild symptoms, or symptoms that have been present for a short time, non-surgical treatment is usually recommended. Carpal tunnel syndrome that occurs during the later stages of pregnancy (which is quite common) is also often treated non-surgically. You may be able to try one of the following.

• Wrists splints. These can help keep your wrist straight and reduce pressure on the median nerve. They are recommended for use at night.
  
• Improving your posture, particularly when working at a desk and using a keyboard. Speak to your HR or occupational health department for more information.
  
• Medicines. Corticosteroid injections can help reduce inflammation in your wrist.
  

However, if your condition is severe and your GP has referred you for surgery, this is usually as a last resort to help relieve your symptoms.

Preparing for carpal tunnel release surgery

Your surgeon will explain how to prepare for your procedure. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Carpal tunnel release surgery is usually done under local anaesthesia. This means you will be awake during the procedure, but won’t feel any pain in your wrist and palm area. You can eat and drink as usual before having a local anaesthetic.

You may also be offered a sedative. This relieves anxiety and helps you to relax.

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 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. Your surgeon 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 passes quickly.

The exact procedure will then depend on whether you are having open or keyhole surgery. Both types usually take about 10 to 20 minutes to complete.

Open carpal tunnel release surgery

In open surgery, your surgeon will make a single cut (3–4cm long) near the base of your palm. He or she will then cut 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

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Keyhole carpal tunnel release surgery

Depending on the technique your surgeon uses, he or she will make either one or two small cuts (about 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 cut your carpal ligament, relieving the pressure on the median nerve. Your surgeon will close the cuts in your skin with stitches.

How keyhole carpal tunnel surgery is carried out

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What to expect afterwards

Your surgeon may ask you to wear a wrist splint and sling after the procedure for a few days or, occasionally, up to a week

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. If you had a sedative, you will need to rest until the effects have passed.

You may need pain relief to help with any discomfort as the anaesthetic wears off. Your nurse will usually give you paracetamol or ibuprofen to take.

You will usually be able to go home when you feel ready. If you've had sedation, you will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

Sedation temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your surgeon's advice.

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 amount of time your stitches will take to disappear depends on the type of stitches you have. However, for these procedures, dissolvable stitches should usually disappear in about seven to 10 days. Non-dissolvable stitches are removed 10 to 14 days after surgery.

Recovering from carpal tunnel release surgery

It usually takes about four 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.

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

During the day, you should keep your arm in the sling for the first two or three days after your operation. At night, try to keep your hand elevated on two pillows in your bed for the first two or three nights.

Your surgeon may advise you to do some gentle finger-stretching exercises to help reduce stiffness in your hand. This may include straightening and bending your fingers into your palm to make a fist, or gently squeezing a foam ball. You should also try to move your elbow and shoulder regularly to loosen your joints.

What are the risks?

Carpal tunnel release surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

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
  
• scarring (open surgery can leave a slightly bigger scar than keyhole surgery, but this usually fades over time)

Complications

This is when problems occur during or after the procedure.

As with any surgery there is a risk of infection, but this is rare for carpal tunnel release surgery. However, you should contact your GP, or the hospital, if:

• you have increasing pain or pain that can't be controlled with painkillers
  
• you have a high temperature
  
• your wrist feels unusually hot to the touch
  
• you have discharge or bleeding from your wounds
  

Complications specific to carpal tunnel surgery are uncommon but can include the following.

• 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.
  
• Re-occurrence. It’s possible that the symptoms of carpal tunnel syndrome may return.

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

The exact risks are specific to you and differ for every person, so we haven’t included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.