Carpal tunnel release surgery

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 will ease pressure on a nerve that controls movement of your thumb and feeling in your hand.

Uses of 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 a 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. Ask your doctor if you have any questions. If you’re happy to go ahead, you’ll be asked to sign a consent form, so it’s important that you understand what will happen during and after the operation.

Preparation 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.

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 any rings on your fingers 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 blood thinning (anticoagulant) medicines, you may be asked to stop taking these for a few days beforehand, but not always. Only stop taking medicines if you’re told to by your doctor – it’s important to follow their advice.

Carpal tunnel release surgery

You usually lie on your back for carpal tunnel release surgery, but you may prefer to sit up on pillows instead. Your arm will be stretched out on an operating board by your side.

Your surgeon will give you 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 or keyhole (endoscopic) surgery.

• In open surgery, your surgeon will make a cut near the bottom of your palm. They’ll use a blade to divide your carpal ligament. This will widen the carpal tunnel and ease pressure on your median nerve. Your surgeon will close the cut in your skin with stitches, and put a bandage around your hand.
• In keyhole surgery, your doctor will make one small cut (portal) in your skin near to your carpal tunnel. They’ll 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.

Your surgeon will discuss in advance whether you’ll have open surgery or keyhole surgery. Surgeons who perform keyhole surgery need appropriate training and experience, as well as specialised equipment.

Aftercare following carpal tunnel release surgery

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. If you keep your arm up (elevated) and wriggle your fingers regularly, it 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. Most people recover from carpal tunnel syndrome surgery in less than a month. But it may take longer to get all the feeling back in your hand if you’ve had carpal tunnel syndrome for a long time.

Some people find their symptoms don’t clear up completely after surgery and the operation will only partially relieve symptoms. But most notice their symptoms aren’t getting worse as quickly. You may take longer to recover from a carpal tunnel operation 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 a pharmacist for advice if you have any questions.

Bandages and stitches

You’ll be able to take off the bandage on your hand after a few days. You’ll still need to keep the wound dry for a week or two. 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 put a plastic bag over your hand when you wash, or have a shower or bath.

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. It may help the scar to heal if you massage both your scar and the area around it with a moisturising cream.

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. You might find you have some restrictions after carpal tunnel surgery . Don’t let your hand dangle when you’re walking and rest your hand in your lap when you sit 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

If you use your hand too much, too soon, it 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.

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, and make sure:

• any pain or discomfort isn’t affecting your concentration or movement
• any painkillers you’re taking aren’t making you feel tired
• 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
• do 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.

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 6-12 weeks after surgery. Some people find they’re ready to go back to work within about two weeks. You may be ready sooner if you can do lighter duties. You may be able to return to a desk-based job after a few days, for example. 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. Don’t do anything that puts too much strain on your hands, such as:

• type for extended periods
• use a phone
• lift 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 some 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. It may affect your day-to-day activities.
• Damage to nerves in your wrist. This may cause temporary pain and numbness in your hand. In some patients, this 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 rare. Tell your surgeon if you have 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. You may need to have more surgery.

Sepsis (adults)

• 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.