Carpal Tunnel Surgery

The median nerve and tendons that enable your fingers to bend run from your forearm into the palm and go through a narrow, rigid passageway of ligament and bones at the base of the hand called the carpal tunnel. Aside from providing feeling to the fingers (except the little finger), the median nerve also controls some small muscles at the base of the thumb.

Carpal tunnel syndrome is a neurological disorder that occurs when the median nerve is pressed or squeezed at the wrist. Early symptoms of carpal tunnel syndrome include numbness, particularly at night, a feeling the fingers are useless or swollen and/or a tingling sensation or pain in the fingers.

As carpal tunnel syndrome progresses, symptoms may worsen, which may cause:

• Tingling during the day, especially with certain activities, such as driving
• Mild to severe pain that sometimes worsens at night
• Some loss of movement in the hand
• Hand weakness that makes it difficult to grasp small objects or perform other manual tasks

Doctors usually recommend nonsurgical options as part of carpal tunnel syndrome treatments, such as anti-inflammatory or shots of corticosteroid medicine, rehabilitation and wrist splints combined with workplace changes to improve posture when using computers or other equipment. If these treatments fail to help with the symptoms or only provide temporary relief, your doctor may order an electromyogram or EMG to test the electrical activity of your median nerve and confirm if you are a candidate for carpal tunnel surgery (also known as carpal tunnel release surgery).

What Is Carpal Tunnel Release Surgery?

Carpal tunnel surgery is one of the most common and effective surgical procedures for carpal tunnel syndrome. The procedure involves cutting a ligament to relieve the pressure on the nerve. Surgeons perform carpal tunnel surgery through one of two different surgical techniques:

• Open carpal tunnel release – a traditional procedure used to correct carpal tunnel syndrome, which involves making an incision of up to 2 inches in the wrist, allowing surgeons to cut the carpal ligament and enlarge the carpal tunnel. Patients are under local anesthesia throughout the procedure on an outpatient basis unless unusual medical conditions require a hospital setting.
• Endoscopic carpal tunnel release – a minimally invasive surgical procedure that may allow faster functional recovery and less postoperative discomfort than traditional open-release surgery. However, endoscopic surgery may also have a higher risk of complications and require additional surgery. This procedure involves inserting a miniature camera attached to a tube through one or two incisions (about ½ inch each), called portals in the wrist and palm. Endoscopic surgery allows surgeons to observe the nerve, ligament and tendons on a monitor and cut the transverse carpal ligament that holds the joints together with a special knife inserted through the tube.

How Carpal Tunnel Release Surgery Works

Carpal tunnel surgery works by removing the pressure on your median nerve by cutting the transverse carpal ligament that forms the roof of the carpal tunnel. By opening this ligament, there is more room for the tendons and the nerve to pass through the carpal tunnel without pressure and allows appropriate blood flow to the nerve and function.

When Is Carpal Tunnel Bad Enough for Surgery?

Only a small percentage of patients require carpal tunnel surgery. Doctors recommend carpal tunnel surgery if symptoms persist and problems with painful sensations worsen despite trying other nonsurgical treatments. Acute carpal tunnel syndrome with sudden and severe pain is rare and often occurs after an injury, infection or bleeding in the wrist. Having surgery right away is often the only way to get long-lasting pain relief.

How Long Does Carpal Tunnel Release Surgery Take?

Carpal tunnel surgery usually lasts anywhere between 15 to 30 minutes.

How Long Is Recovery for Carpal Tunnel Release Surgery?

The outcomes of both open and endoscopic carpal tunnel surgery are similar. Patients are encouraged to elevate the affected hand above the heart and move the fingers to reduce swelling and prevent stiffness immediately after carpal tunnel surgery. Some residual numbness or weakness, swelling and stiffness are common after the procedure. Minor soreness in the palm may last several weeks to several months. However, if there is still significant pain and weakness for over two months, rehabilitation may be required to maximize carpal tunnel surgery recovery time after surgery.

For most patients, carpal tunnel surgery recovery time may be gradual and complete recovery may take up to a year. Having conditions such as arthritis or tendinitis and severe carpal tunnel syndrome may slow a patient’s overall recovery. There are cases where complete healing may not be possible. Recurrence of carpal tunnel syndrome is rare following carpal tunnel surgery. However, if this happens, additional treatment or surgery may be recommended.