Carpal tunnel release surgery
Your health expert: Mr Ian Grant, Consultant in Plastic Surgery and Hand Surgery
Content editor review by Victoria Goldman, April 2023
Next review due April 2026
Carpal tunnel release surgery is an operation to ease the symptoms of carpal tunnel syndrome (CTS). The symptoms include numbness, weakness, tingling and pain in your hand. The operation involves dividing a ligament in your wrist. This eases pressure on a nerve that controls movement of your thumb and feeling in your hand.
How open carpal tunnel surgery is carried out
Carpal tunnel syndrome | Symptoms | Carpal tunnel release surgery - watch in 2 minutes 15
Carpal tunnel syndrome can cause pain, discomfort and numbness. This video explains what carpal tunnel syndrome is and describes a type of treatment called open carpal tunnel surgery.
About carpal tunnel release surgery
Carpal tunnel release surgery (carpal tunnel decompression) is an operation that 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. Your median nerve controls movement in your thumb. It also controls a lot of the feeling in your hand.
In carpal tunnel syndrome, your median nerve gets compressed (squeezed into a smaller space). This usually causes tingling, numbness and pain in your hand. Dividing the carpal ligament during surgery releases the pressure in your carpal tunnel. This can ease your symptoms.
Why do I need carpal tunnel release surgery?
You may be offered carpal tunnel release surgery if:
- you have severe symptoms (which may include significant weakness and continuous numbness)
- you’ve tried other treatments, such as wrist splints and steroid injection, and you’re still getting symptoms
Your GP may refer you to a hand specialist or local musculoskeletal service for tests and treatment. The specialist will be able to tell you if surgery may be an option for you and the risks and benefits involved. They can help you to decide whether or not surgery is right for you. Be sure to ask your doctor any questions you have. If you’re happy to go ahead, you’ll be asked to sign a consent form, so it’s important that you feel informed.
Preparing for carpal tunnel release surgery
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 straight 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’ll be awake for the operation, but the area being operated on will feel numb. You must remove any jewellery from your hand or fingers before surgery. It is your responsibility to remove a tight ring before you come to the hospital.
Your doctor will let you know if there’s anything else you need to do to prepare before your operation. If you’re taking any anticoagulant (blood thinning) medicines, you may be asked to stop taking these for a few days beforehand. Only stop taking medicines if you’re told to by your doctor – it’s important to follow their advice.
What happens during carpal tunnel release surgery?
A member of the theatre staff will check you’re in a comfortable position. You usually lie on your back for carpal tunnel release surgery, but you may prefer to sit up instead. Your arm is stretched out on a special operating board by your side.
You’ll be given a local anaesthetic injection so you won’t feel any discomfort during the procedure. Your surgeon will check that the anaesthetic has worked before starting the operation. You may still feel some pressure, but you shouldn’t feel any pain.
Carpal tunnel release surgery can be performed in two ways: open surgery and endoscopic (keyhole) surgery.
- In open surgery, your surgeon makes a cut near the bottom of your palm. They’ll use a special knife to divide your carpal ligament. This will widen the carpal tunnel and ease pressure on your median nerve. The cut in your skin is closed with stitches. A bandage is put around your hand.
- In keyhole surgery, your doctor makes one or two small cuts (portals) in your skin near to your carpal tunnel. They then put in a tiny camera to see inside your hand and wrist. They’ll also put in other tiny instruments to perform the surgery and cut your carpal ligament. This avoids placing a surgical scar on the palm of your hand.
Your surgeon will discuss in advance whether you will be having open surgery or keyhole surgery. Surgeons who perform keyhole surgery need appropriate training and experience, as well as special equipment.
What to expect afterwards
After having 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 comes back.
Carpal tunnel release surgery isn’t usually very painful. But you may need over-the-counter painkillers such as ibuprofen or paracetamol to ease any discomfort once the anaesthetic wears off.
Your bandage will protect and support your hand, but you should still be able to wriggle your fingers. The bandage on your hand should feel comfortable and supportive rather than tight. Keeping your arm up (elevated) and wriggling your fingers regularly will help to:
- keep your blood flowing properly
- reduce any swelling and stiffness
You’ll usually be able to leave the hospital when you feel ready. Before you leave, your nurse will give you some advice about caring for your healing wound. You may be given a date for a follow-up appointment.
Recovering from carpal tunnel release surgery
Everyone recovers differently from carpal tunnel surgery. But most people have full power back in their hand between six and 12 weeks after surgery.Some peoplefind their symptoms don’t clear up completely after surgery, but most of them will notice their symptoms aren’t getting worse as quickly. You may take longer to recover if you have:
- more severe carpal tunnel syndrome
- a long-term condition such as diabetes
Pain relief
The cut on your hand may feel a bit sore for the first day or two. This should settle down, but you may continue to have some soreness or discomfort in your hand for some weeks afterwards. 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.
Bandages and stitches
You’ll be able to take off the bandage on your hand after two to three days. You’ll still need to keep the wound dry for around a week. Your surgeon will tell you whether you have absorbable stitches or stitches that need to be removed. If your stitches need to be removed, this is usually done around 10 to 14 days after your operation. It can help to wear a large rubber glove or plastic bag over your hand when you’re washing or bathing.
You’ll have a noticeable scar if you’ve had open surgery. It may look lumpy and pink at first and feel tender. This usually settles down within a few months. Massaging your scar and the area around it with a simple moisturising cream such as E45 may help the scar to heal.
Using your hand
In the first couple of days after surgery, you can use your hand for light tasks such as:
- holding a glass or a book
- gently using a computer keyboard
When you’re not using your hand, hold it up (elevate it) at all times. Don’t let your hand dangle when you’re walking or rest in your lap when you’re sitting down. As time goes on and your hand heals, you’ll be able to build up to activities such as brushing your teeth or your hair.
It can be painful or uncomfortable to grip at first, but this should return to normal between six and 12 weeks after your operation. Sometimes, your surgeon may refer you to a specialised physiotherapist, called a hand therapist, to help with your recovery.
Exercises to help your recovery
Using your hand too much, too soon, may cause pain and delay your recovery. So be sure to take things slowly and don’t do too much. It’s best to be guided by your surgeon, GP or physiotherapist and what feels right for you.
Your surgeon or physiotherapist may suggest you do some specific hand and wrist exercises after your surgery. But don’t do any exercises without checking with them first. It is important to get some advice on how soon to start these exercises. These are some examples of simple exercises you may be able to try.
- 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. You can rest your elbow on a table while you’re doing this.
- Touch the tip of each finger to your thumb in turn.
- 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.
Driving after carpal tunnel release surgery
You don’t need to tell the Driver and Vehicle Licensing Agency (DVLA) about your surgery unless your recovery is likely to take longer than three months. But it is your responsibility to check with your insurance company – some insurers won’t cover you for several weeks after surgery.
Before you go back to driving after carpal tunnel release surgery, check with your surgeon that it’s safe for you to do so. 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’re likely to need some time off work to recover. How long you’ll need to take off will depend on:
- the type of job you do
- how quickly you recover from the surgery
Your hand may be weak for about six weeks after surgery. Some people find they’re ready to go back within about two weeks. You may be ready sooner if you can do lighter duties. But it may take longer if you do heavy manual work.
Your surgeon can give you advice on when to go back to work. They can complete a ‘return to work’ form if this is needed by your employer. If you need more time, you can discuss this with your GP, surgeon or occupational health service, if you have one at work.
When you do return to work, you may need to take things easy at first. You may have to avoid anything that puts too much strain on your hands, such as:
- typing for extended periods
- using a phone
- lifting heavy items
Complications of carpal tunnel release surgery
Complications are problems that may happen during or after your procedure. All surgical procedures carry a risk of certain complications.
The most common complications associated with carpal tunnel release surgery include the following. Your surgeon can explain how these may apply to you.
- Infection of your wound. This can be treated with antibiotics.
- Bleeding. This may form a collection of blood under your skin (a haematoma).
- A tender and sensitive scar. This is a minor issue for most people and gradually gets better. But some people find that scar is uncomfortable for months or years. It may affect their day-to-day activities.
- Damage to nerves in your wrist. This may cause temporary pain and numbness in your hand. In rare cases, loss of feeling and strength in your hand may be permanent.
Other problems associated with carpal tunnel release surgery – for example, pain that doesn’t go away – are very rare. Do tell your surgeon if you’re experiencing any problems. If necessary, they can refer you for more treatment, including physiotherapy.
Most people find their symptoms of carpal tunnel syndrome 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.
Sepsis (adults)
- You can get an infection after surgery. This usually just affects the area around your wound. But in rare cases, the infection can spread. Sepsis is a life-threatening complication that can develop if you get an infection. It is a medical emergency. Call 999 or go to A&E immediately if you have any of the following symptoms. Slurred speech, confusion, difficulty making sense.
- Extreme shivering or muscle pain.
- Passing no pee (urine) during a day.
- Severe difficulty breathing, feeling breathless, or breathing very fast.
- It feels like you’re going to die.
- Skin changes such as your skin looking blue, pale or blotchy, or a rash that does not fade when you roll a glass over it.
Looking for physiotherapy?
You can access a range of treatments on a pay as you go basis, including physiotherapy.
To book or to make an enquiry, call us on 0370 218 6528∧
Some exercises may help your hand to recover more quickly. But it’s best to be guided by your surgeon or physiotherapist and what feels right for you. Overdoing exercises can also delay your recovery, so be sure to take things slowly and don’t do too much. For more information, see our section on recovering from carpal tunnel release surgery.
You won’t be able to drive home after the operation. You can’t drive until you can move your hand and wrist well enough and without pain to drive safely. For more information, see our section on recovering from carpal tunnel release surgery.
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