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Carpal tunnel release surgery

Expert reviewers Giles Bantick, Consultant Plastic Surgeon and Hand Surgeon, and Dr Yasmin Rahman, Bupa Clinics GP
Next review due September 2023

Carpal tunnel release surgery is an operation to relieve symptoms of carpal tunnel syndrome (CTS), including 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 in your hand.

About carpal tunnel release surgery

Carpal tunnel release surgery – also called 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, which controls movement and feeling in your hand, run through this tunnel to your fingers. In carpal tunnel syndrome, your median nerve becomes compressed, typically causing tingling, numbness and pain in your hand. Dividing the carpal ligament releases the pressure in your carpal tunnel and can ease your symptoms.

Image showing the carpal tunnel and median nerve

Why do I need carpal tunnel release surgery?

You may be offered carpal tunnel release surgery if you have particularly severe symptoms, or you’ve tried other treatments, such as wrist splints and steroid injections, and you’re still having problems.

If this is the case, your GP may refer you to a hand specialist, or local musculoskeletal service for further investigation and treatment. The specialist will be able to tell you whether surgery might 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.

 

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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 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’ll be awake for the operation, but the area being operated on will feel numb. It’s best to remove any jewellery on your wrist or fingers before you come in for your operation, and leave it at home.

Your doctor will let you know if there’s anything else you need to do to prepare before your operation. For instance, 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 medications if told to by your doctor – it’s important to follow their advice.

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 placed 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 a local anaesthetic injection so you won’t feel any discomfort during the procedure. Your surgeon will check whether the anaesthetic has taken effect before starting the operation. You may still feel some pressure, but you shouldn’t feel any pain. If you do feel any pain, tell your surgeon – occasionally the local anaesthetic may need topping up.

There are two main ways in which carpal tunnel release surgery can be performed: 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, widening the carpal tunnel and relieving pressure on your median nerve. The cut in your skin is closed with stitches, and a bandage applied around your hand.
  • In keyhole surgery, your doctor makes one or two small incisions (‘portals’) in your skin near to your carpal tunnel. They then insert a miniature camera to see inside your hand and wrist, and other tiny instruments to perform the surgery and cut your carpal ligament. It means that the skin and tissue above your carpal tunnel doesn’t need to be damaged.

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 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. Keeping your arm elevated and wriggling your fingers regularly will help keep your blood flowing properly, and 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

How long it takes to recover from carpal tunnel surgery varies from person to person, as everyone responds to surgery differently. But generally, most people have full power back in their hand between six and 12 weeks after surgery.

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 remove the bandage on your hand after two to three days, but you’ll still need to keep the wound dry until the stitches have been taken out. This is usually around 10 to 14 days after your operation. It can help to wear a large rubber glove or plastic bag over your hand when your washing or bathing.

You will have a noticeable scar that 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 cream such as E45 can help in the meantime.

Using your hand

You can use your hand for light tasks in the first couple of days after surgery, such as holding a glass or book, or gently using a computer keyboard. When you’re not using your hand, keep it elevated at all times.

Don’t let it dangle as 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 like brushing your teeth or your hair.

If you’re feeling pain during movement, stop for a while in case you’re doing too much, too soon. 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 rehabilitation. We have more information on exercises you can do to help your recovery in our FAQs below.

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 and how quickly you recover from the surgery. Many people find they’re ready to go back within about two weeks, but it may be sooner if you can do lighter duties, or longer if you do heavy manual work. It’s your decision when you feel ready to go back to work. Your surgeon should be able to provide a sick note if you need one following your surgery. If you need more time, you can discuss this with your GP, surgeon or occupational health service, if you have one at your place of work.

When you do 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 for extended periods, using a phone or 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 the risk of these apply to you.

  • Infection of your wound. This can be treated with antibiotics.
  • Bleeding, which may form a collection of blood under your skin (a haematoma).
  • A tender and sensitive scar. This is a minor issue for most people that gradually improves. However, some people find that the problem continues for months or years, and interferes with 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, such as ongoing problems with pain, 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.

Frequently asked questions

  • Using your hand as soon as possible after carpal tunnel release surgery will help to reduce swelling and stiffness. But it’s best to be guided by your surgeon or physiotherapist and what feels right for you, as to how much to do. Overdoing exercises can also delay your recovery, so be sure to take things slowly and don’t do too much.

    The following are some examples of simple hand and wrist exercises that your surgeon or physiotherapist may ask you to 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. You can rest your elbow on a table while you’re doing this.
    • 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.

    Try to use normal day-to-day activities, such as getting dressed, brushing your teeth and typing, 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.

    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.

  • There are a number of factors you should consider before you start driving again after carpal tunnel release 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.

    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 you should check with your insurance company because some insurers won’t cover you for a number of weeks after surgery.



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Related information

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  • Reviewed by Pippa Coulter, Freelance Health Editor, September 2020
    Expert reviewers Giles Bantick, Consultant Plastic Surgeon and Hand Surgeon, and Dr Yasmin Rahman, Bupa Clinics GP
    Next review due September 2023

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