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Carpal tunnel release surgery

Published by Bupa's health information team, October 2008.

This factsheet is for people who are planning to have surgery to treat carpal tunnel syndrome, or who would like information about it.

Carpal tunnel syndrome is tingling, numbness and pain in your hand (and sometimes forearm) caused by pressure on a nerve in your wrist. Carpal tunnel release surgery involves cutting the carpal ligament to relieve the pressure on the nerve.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About carpal tunnel surgery
What are the alternatives to surgery?
Preparing for your operation
About the operation
Animation - How keyhole carpal tunnel surgery is carried out
Animation - How open carpal tunnel surgery is carried out
What to expect afterwards
Recovering from carpal tunnel surgery
What are the risks?
Further information
Questions and answers
Related topics
Sources

About carpal tunnel surgery

The bones of your wrist are arranged in a semi-circle, and a tough ligament called the transverse carpal ligament forms a roof over them, creating a channel (the carpal tunnel). The carpal tunnel is in the palm side of your wrist. Running through your carpal tunnel are the tendons that you use to bend your fingers, and your median nerve. The median nerve is one of three nerves that connect to your hand. The median nerve controls some of the muscles that move your thumb. Any swelling of the tissue in or around the carpal tunnel can put pressure on your median nerve, causing tingling, numbness or pain in your hand, wrist and forearm.

Illustration showing the carpal tunnel and median nerve
The carpal tunnel and median nerve

Carpal tunnel release surgery is recommended if your symptoms are severe. The operation involves cutting the carpal ligament to relieve the pressure on the median nerve.

What are the alternatives to surgery?

There are several non-surgical treatment options available to help relieve your symptoms.

Self-help. Changing the way you make repetitive movements, reducing how often you do them, increasing the amount of rest between periods of activity and gentle stretching exercises may help to relieve mild symptoms.
Medicines such as corticosteroid injections can help reduce inflammation.
Wrists splints can help keep your wrist straight and reduce pressure on the median nerve and are often recommended for use at night.

Sometimes the symptoms improve without treatment, especially in women who develop carpal tunnel syndrome during pregnancy.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. 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 routinely done as a day case. This means you have the procedure and go home the same day.

The operation is usually done under a local anaesthetic. This completely blocks feeling from your wrist and palm area, but you will stay awake. You may be offered a sedative to help you relax during the operation. If you have a sedative, you will have very little memory of the test, afterwards. You can eat and drink as usual before having a local anaesthetic.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the operation

You may be asked to sit in a chair and rest your arm on the operating table, or lie on the operating table with your hand out to the side. Tight compression (a tourniquet) may be applied to your upper arm to stop blood flowing to your hand during the operation. Your surgeon will inject a local anaesthetic into your wrist and in the palm of your hand. You will feel a sharp sensation, which passes quickly.

The operation usually takes 10 to 20 minutes.

Laparoscopic (keyhole) release surgery

A small cut (2cm long) is made in your forearm just above the wrist or in the palm of your hand. A narrow, tube-like telescopic camera (endoscope) is passed into the cut to help see inside the wrist either by looking directly through this, or at pictures it sends to a video screen. Using a special instrument attached to the endoscope the carpal ligament is cut. The skin cut is closed with stitches.

How keyhole carpal tunnel surgery is carried out

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Open release surgery

A single cut (5cm long) is made in the front of the wrist at the base of your palm. A cut is made into the carpal tunnel to access the ligament. The carpal ligament is cut.

The carpal tunnel and skin cut are closed with stitches.

How open carpal tunnel surgery is carried out

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What to expect afterwards

You may have a wrist splint fitted and your arm put in a sling. You will need to rest until the effects of the sedative have passed. You will be able to go home when you feel ready.

You will need someone to drive you home. You should have someone to stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your healing wound before you go home. You may be given a date for a follow-up appointment.

Dissolvable stitches will disappear in seven to 10 days. Non-dissolvable stitches are removed 10 to 14 days after surgery.

Recovering from carpal tunnel surgery

Your wrist and hand may be numb, take special care not to bump or knock it. You may feel some discomfort as the anaesthetic wears off. Painkillers can help with this.

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

Sedatives can temporarily affect your coordination and reasoning skills, so you must not drink alcohol, operate machinery or sign legal documents until your surgeon tells you that it's safe to do so. This will be at least 24 hours after your procedure.

You should keep your arm in the sling during the day for the first two or three days. In the night, keep your hand elevated on two pillows in bed.

You should do gentle finger stretching exercises, such as straightening and bending your fingers into your palm to make a fist, or gently squeezing a foam ball. These help reduce stiffness. You should also move your elbow and shoulder regularly to loosen your joints.

Follow your surgeon's advice about driving and returning to work. A full recovery can take six weeks, although with keyhole surgery you may be able to get back to your usual activities much quicker.

You will have a scar, which may feel quite firm and tender. Massaging the area firmly with a moisturising cream such as E45 can help to relieve this.

Contact your GP if you develop any of the following symptoms as you may have developed an infection:

increasing pain or pain that can't be controlled with painkillers
high temperature
wrist feels unusually hot to the touch
discharge or bleeding from the wound

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

These are the unwanted but mostly temporary effects of a successful treatment. Side-effects of carpal tunnel surgery include:

pain and discomfort in your wrist and hand
scarring - open surgery can leave a slightly bigger scar but this usually fades gradually over time

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection or excessive bleeding.

Complications specific to carpal tunnel surgery are uncommon but can include:

damage to nerves, blood vessels or tendons in the wrist - this may require further surgery to repair the damage
loss of strength when pinching or gripping objects - this is usually temporary and improves as the wrist heals
continuing pain and numbness - sometimes it can take several months for the discomfort to disappear
re-occurrence - it's possible symptoms of carpal tunnel syndrome may return

With keyhole surgery, there is a chance your surgeon may need to convert the keyhole procedure to open surgery.

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

Further information

Arthritis Research Campaign
0870 850 5000
www.arc.org.uk