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Carpal tunnel release surgery

Carpal tunnel release surgery is an operation to relieve symptoms of carpal tunnel syndrome (CTS). These can include numbness, tingling and pain in your hand. The operation involves dividing a ligament in your wrist to relieve pressure on a nerve that controls movement and feeling.

Open carpal tunnel surgery
How open surgery is carried out

About carpal tunnel release surgery

If your carpal tunnel syndrome symptoms are affecting your quality of daily life, your GP may suggest you have carpal tunnel release surgery. The surgery has several pros and cons, so your GP will discuss with you whether or not it’s right for you. You will then be referred to a surgeon who specialises in carpal tunnel surgery.

Carpal tunnel release surgery (carpal tunnel decompression) involves cutting your carpal ligament. This ligament is connected to bones in your wrist to form the carpal tunnel. Several tendons and your median nerve run through this tunnel to your fingers. If pressure builds up in the carpal tunnel, your median nerve can’t work properly and causes tingling, numbness or pain. Dividing the carpal ligament releases the pressure and eases your symptoms.

Image showing the carpal tunnel and median nerve

Preparing for carpal tunnel release surgery

Before your carpal tunnel release surgery, you’ll meet the surgeon carrying out your operation to discuss your care. It may be different to what’s described here, as it will be designed to meet your individual needs.

Carpal tunnel release surgery is a day-case procedure. This means you’ll have the operation and go home on the same day. There’ll be no need to pack an overnight bag or make any arrangements for being away. You won’t be able to drive immediately after your surgery, so make sure you arrange to get a lift home.

Carpal tunnel release surgery is usually done under local anaesthesia. This means you will be awake for the operation, but won’t feel anything. Make sure that you clean your hands and remove any jewellery on your wrist or fingers beforehand. For more information read our section: What happens during carpal tunnel release surgery?

Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, this is your chance to ask any questions you have. If you’re happy to go ahead with the operation, you will be asked to sign a consent form. If you are taking any anticoagulant (blood thinning) medicines such as warfarin, it is important that you tell your surgeon before your surgery.

What are the alternatives to carpal tunnel release surgery?

If your carpal tunnel syndrome symptoms are mild or you’ve had them for only a short while, you may not need surgery. If you’re under 30 or pregnant, you may not need surgery either. This is because your symptoms may go away on their own after around six months, or once you’ve had your baby.

You may be able to ease your symptoms with some lifestyle changes such as the following:

  • avoid doing anything that makes your symptoms worse
  • take regular breaks from repetitive tasks
  • if you use a computer, try a different keyboard or a wrist rest
  • keep fit and maintain a healthy weight – being overweight and unfit are both linked to carpal tunnel syndrome

If your symptoms are affecting your everyday life, your doctor may recommend non-surgical treatments.

  • Wrist splints. These support your wrist and keep it in a neutral position. Wearing these at night can often help with night-time symptoms, particularly if you have mild carpal tunnel symptoms during pregnancy.
  • Steroid injections. A steroid injection into your wrist is often recommended to treat most mild to moderate cases of carpal tunnel syndrome. It can be helpful if wrist splints aren’t easing your symptoms.

If these treatments aren’t working or your symptoms are bad, your GP may recommend carpal tunnel release surgery.

What happens during carpal tunnel release surgery?

You usually lie on your back for carpal tunnel release surgery, with your arm stretched out on a special operating board by your side. Your nurse will check that you’re in a comfortable position. You may have a tourniquet around the top of your arm. A tourniquet is a tight cuff that stops blood flow in your arm during the operation.

You’ll be given local anaesthetic injections so you won’t feel any discomfort during the procedure. Your surgeon will test whether or not you can feel any pain before starting the operation. You may still feel some pressure once the anaesthetic is working. If this happens, tell your surgeon so that you can have a higher dose of anaesthetic.

The tourniquet is then inflated, a bit like a blood pressure cuff used to take blood pressure. It inflates until it completely stops blood flowing into your hand. Once the tourniquet is inflated, your surgeon can start the operation, which takes about 20 minutes.

Your surgeon will make a cut near the bottom of your palm, and divide your carpal ligament to relieve pressure on your median nerve. Once this is done, your surgeon will close the cut in your skin with stitches and apply a bandage. You may be advised to wear a wrist splint.

What to expect afterwards

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 your hand, and be extra careful around anything hot such as kettles or radiators. You may feel tingling in your hand as the anaesthetic wears off and the feeling in your wrist and hand returns.

Carpal tunnel release surgery isn’t usually painful. But you may need pain-relief medicines such as ibuprofen or paracetamol to ease any discomfort.

Your bandage will protect and support your hand, but you will still be able to wriggle your fingers. Keeping your arm up will help to reduce any swelling. Wriggle your fingers regularly to keep your blood flowing properly, and to reduce any stiffness.

Before you go home, your nurse will give you some advice about caring for your healing wound. It’s important to keep your bandage dry after your operation. This means wearing a rubber glove or plastic bag when you have a bath or shower.

You’ll usually be able to leave the hospital when you feel ready. Before you leave, you may be given a date for a follow-up appointment. This is usually six to eight weeks after your surgery.

Recovering from carpal tunnel release surgery

Carpal tunnel surgery recovery time varies from person to person, as everyone responds to surgery differently. It’s important to take it easy at first, but moving your fingers, hand and wrist as soon as possible will help you recover more quickly.

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

One or two days after surgery. The cut on your hand may feel a bit sore. When you’re not using your hand, keep it up at all times. Try to get your fingers moving and use your hand for light tasks such as holding your glass or a book. You could even try using a computer keyboard, though only gently.

Three to 14 days after surgery. You can now remove the bandage, but you’ll still need to keep the wound dry until the stitches have been taken out. Try building up to activities like brushing your teeth or your hair. Keep doing this while your hand heals. If you’re feeling pain during movement, stop for a while in case you’re doing too much too soon. You need to build up gradually, so use pain as a guide for what you can and can’t do.

From two weeks after surgery. Your stitches will be removed around 10 to 14 days after your operation. If your surgeon has used dissolving stitches, these will usually disappear on their own after around two to three weeks. You’ll now be able to get your wound wet, which will make it easier for you to have a bath or shower.

When your stitches are removed, you may notice your scar is:

  • firm
  • tender
  • lumpy
  • pink

It’s normal for your scar to feel tender after the operation, but this usually settles down within a few months. Massaging your scar and the area around it with a simple cream such as E45 can help to make it feel less tender. Your scar should begin to look better after around three months.

You may find your grip is weaker than it was before your surgery. So bear in mind that gripping too hard may be painful at first – avoid doing this when you can. Your grip should return to normal between six and 12 weeks after your operation. For more information, see our FAQs: Physiotherapy after carpal tunnel release surgery and Exercise after carpal tunnel release surgery.

You may be able to return to light work after around 12 days, and your full working activities after around 19 days. But obviously this will depend on how quickly you recover from the surgery, and what your job involves. See our section: Returning to work after carpal tunnel release surgery.

Driving

After carpal tunnel release surgery, there’s no right or wrong time to return to driving. You don’t need to tell the DVLA about your surgery unless your recovery is likely to take longer than three months. But you should check with your insurance company because some insurers won’t cover you for a number of weeks after surgery.

Before you drive, you should:

  • have fully recovered from the local anaesthetic
  • make sure any pain or discomfort isn’t affecting your concentration or movement
  • make sure any painkillers you’re taking aren’t making you feel tired
  • make sure you can move your hand and wrist well enough to drive safely

Check that you can:

  • sit in the driving seat in a comfortable position
  • grip and control the steering wheel properly
  • perform an emergency stop

When you feel comfortable to start driving again, begin with a short journey. Perhaps try driving to the local shops with a friend or family member.

Returning to work

After your surgery, you may need to take time off from work to recover. Everyone recovers at a different speed, so speak to your surgeon and physiotherapist to discuss how and when you should go back to work. Many people find they’re ready to go back to work after around 12 days, but you might feel ready to return to work sooner. This will depend on what type of job you do and how long it takes you to recover from the surgery. Most people are able to go back to their full job after around 19 days. It’s important to be guided by how you feel.

When you return to work, you may need to take things easy at first. For example, you may have to avoid anything that puts too much strain on your hands, such as typing, using a telephone or lifting heavy items.

Side-effects of carpal tunnel release surgery

Side-effects are the unwanted, but often mild and temporary problems you may expect to happen as a result of surgery. Carpal tunnel surgery can cause some side-effects. These may include:

  • pain and discomfort along the cut on your hand
  • stiffness in your hand
  • swelling – keeping your hand up should help to reduce this
  • a noticeable scar that will gradually fade
  • your scar feeling tender after the operation - this usually settles down within a few months
  • having a weaker grip than you had before surgery – this should return to normal as your hand heals

Complications of carpal tunnel release surgery

are unexpected problems that may happen during or after your treatment. As with every procedure, there is a risk of certain complications. This may include the risk of complications linked to having an allergic reaction to the anaesthetic. Outlined below are complications that are more specific to carpal tunnel release surgery. If you are unsure about any of the following complications, ask your surgeon to explain how these may apply to you.

  • A tender and sensitive scar. Your scar may be tender and sensitive for a while after surgery. This is a minor complication and you may find that this sensitivity doesn’t interfere with your day-to-day activities, but for some people, it does.
  • Damage to nerves in your wrist. This may cause pain and numbness, which should eventually disappear.
  • Pain when putting pressure on your hand. This is called pillar pain, and may be caused by a tender, raised scar and swelling at the base of your palm. The pain may affect your grip, but should ease after three to four months.
  • Bowstringing. You may notice that when you flex your wrist after the surgery, your tendons are more visible. This may cause some pain, a snapping sensation when you flex your wrist or pins and needles.
  • Complex regional pain syndrome (CRPS). This rare condition can cause many symptoms, including swelling, burning pain, sensitivity to touch and changes in skin temperature and colour. Your movement may become more limited. CRPS is usually triggered by surgery or accidental damage and can usually be managed with painkillers and other medicines, as well as physiotherapy and counselling.
  • Re-occurrence. Most people find their symptoms disappear after surgery, but there’s a chance that your symptoms may continue or come back. This may be because your carpal ligament wasn’t cut deeply enough to release the pressure. If this happens, you may need to have more surgery.

FAQ: Will I need physiotherapy after the surgery?

Not everyone needs to see a physiotherapist after carpal tunnel release surgery. Your surgeon will assess if physiotherapy (or hand therapy) is right for you, and discuss the pros and cons.

There are some general things that you can do at home to help you recover more quickly.

  • Use your hand for light day-to-day activities such as eating and dressing as soon as you can after surgery.
  • Keep your hand up when you’re not using it.
  • Don’t walk around with your hand dangling down or sit with it in your lap

For more information, see our FAQ: Exercise after carpal tunnel release surgery.

You may need to see a physiotherapist if you still have scar pain or stiffness three months after your surgery. You may be recommended to try strengthening hand exercises, hot or cold compresses or a wrist splint. But these don’t work well for everyone. Massaging your scar and the area around it with a moisturising cream can also help your scar to feel less tender.

FAQ: Can exercises help after carpal tunnel release surgery?

After carpal tunnel release surgery, you’ll need to start using your hand as soon as possible to reduce swelling and stiffness. But it’s best to be guided by your surgeon and what feels right for you.

There are lots of exercises and other ways to help people recover after hand surgery, but doctors don’t really know whether they work or not. Squeezing foam balls to increase your strength and mobility may slow down your recovery if you do it too much. So make sure you take things slowly and don’t do too much.

There are some simple hand and wrist exercises you can do after your surgery.

  • Make a fist by starting with your fingers straight and then moving them down to your palm – do this 10 times.
  • Bend your wrist up and down 10 times.
  • Touch the tip of each finger to your thumb in turn.
  • Press the palms of your hands together with your fingers pointing upwards. Gently lift your elbows to the side, keeping your fingers together, until you feel stretch at the front of your wrists.
  • Rest your arm flat on a table with your wrist hanging over the edge. Bend and straighten your wrist up and down 10 times, then side to side, and then rotate your wrist in circles.

Perhaps try using your normal day-to-day activities to build up the strength and mobility in your hand. If your pain or swelling gets worse after using your hand, it’s likely that you’ve been doing too much and need to slow down. You may also find that your shoulder and neck feel a little stiff after a period of relative inactivity after surgery.

Remember that it can take up to three months for you to recover completely from the surgery. If your hand is still painful or sensitive or your scar is stiff after three months, speak to your surgeon or GP.

Details

  • Carpal tunnel treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including carpal tunnel treatment.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Carpal tunnel syndrome and median nerve lesions. PatientPlus. patient.info/patientplus, last checked May 2014
    • Carpal tunnel syndrome. Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2016
    • Overuse phenomena and RSI. PatientPlus. patient.info/patientplus, last checked May 2014
    • Neurosurgery. Oxford Handbook of Operative Surgery (online). Oxford Medicine Online. oxfordmedicine.com, published May 2017
    • Carpal tunnel release. Royal College of Surgeons. www.rcseng.ac.uk, accessed February 2018
    • Minor surgery. Oxford Handbook of General Practice (online). Oxford Medicine Online. oxfordmedicine.com, published April 2014
    • Anaesthesia explained. The Royal College of Anaesthetists. 5th ed. November 2015. www.rcoa.ac.uk, accessed February 2018
    • Orthopaedics. Oxford Handbook of Operative Surgery (online). Oxford Medicine Online. oxfordmedicine.com, published May 2017
    • Hand anesthesia. Medscape. emedicine.medscape.com, updated August 2015
    • Orthopedic surgery for carpal tunnel syndrome treatment and management. Medscape. emedicine.medscape.com, updated April 2016
    • Assessing fitness to drive – a guide for medical professionals. DVLA. www.gov.uk, published January 2018
    • Complications of hand surgery. Post-operative Complications (online). Oxford Medicine Online. oxfordmedicine.com, published October 2011
    • Common postoperative complications. PatientPlus. patient.info/patientplus, last checked July 2016
    • Orthopaedic surgery. Oxford Handbook of Clinical Surgery (online). Oxford Medicine Online. oxfordmedicine.com, published May 2013
    • Median nerve entrapment. Medscape. emedicine.medscape.com, updated February 2016
    • Complex regional pain syndrome. PatientPlus. patient.info/patientplus, last checked May 2016
    • Peters S, Page MJ, Coppieters MW, et al. Rehabilitation following carpal tunnel release. Cochrane Database of Systematic Reviews 2016, Issue 2. doi:10.1002/14651858.CD004158.pub3
    • Carpal tunnel syndrome: after the operation. The Ipswich Hospital NHS Trust. www.ipswichhospital.nhs.uk, issued October 2016
    • Carpal tunnel post-operative exercises. The Royal Orthopaedic Hospital NHS Foundation Trust. www.roh.nhs.uk, reviewed April 2017
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    Reviewed by Marcella McEvoy, Specialist Health Editor, Bupa Health Content Team, April 2018
    Expert reviewer, Giles Bantick, Consultant Plastic Surgeon and Hand Surgeon
    Next review due April 2021

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