Carpal Tunnel Release
Why is this surgery done?
Carpal tunnel release surgery is performed when a patient with carpal tunnel syndrome is not getting better with nonsurgical treatments such as medications, therapy and wrist splints. Patients with carpal tunnel syndrome will typically have numbness or pins/needle sensations in the palm of the hand, including the thumb, index and middle fingers. Symptoms are commonly made worse with pressure on the wrist, and often will wake the patient up at night. With time, the muscles of the hand can become weak. The symptoms are caused by pressure on the median nerve as it travels into the hand through the carpal tunnel, a canal in the wrist created by the wrist bones with a ligament on top of the nerve. When this ligament gets thickened from overuse, or certain medical issues such as diabetes, the tunnel becomes too small and the nerve does not have enough room. The goal of surgery is to open the ligament to create more room for the nerve.
How is carpal tunnel release done?
Carpal tunnel release surgery is performed through a small (less than one-inch) incision where the wrist meets the palm of the hand. The ligament on top of the nerve is cut and opened from the wrist to the palm under this incision. This does not cause any instability in the wrist or hand. The skin is then closed with stitches that will need to be removed in about two weeks. The surgery often takes less than 20 minutes, and mild sedation and numbing medicine are used. General anesthesia is not required.
What are my risks? What are common complications?
Carpal tunnel release surgery is very safe. Complications are uncommon, but include infection, incision pain, nerve injury and failure to improve symptoms. Patients with diabetes are more likely to have problems with the incision. They are less likely to get significant improvement with surgery, but the surgery typically prevents the symptoms from getting worse.
What do I need to know before surgery?
You may be asked to stop taking some of your medications (aspirin, ibuprofen and blood thinners) one week before your scheduled surgery. Tell your doctor if you’re experiencing any illnesses, such as cold, fever or virus before surgery. You will need someone to drive you home. Do not eat for eight hours prior to surgery.
General discharge instructions
- Don’t grip objects tightly or lift with your affected arm.
- Wear your bandage, splint or cast as directed and keep it clean and dry.
- When showering, use plastic to cover your hand and wrist. (Tape or rubber bands can secure the plastic.) Shower as needed.
- Use an ice pack, bag of frozen peas or something similar wrapped in a thin towel on your wrist. Leave the ice pack on for 20 minutes, then take it off for 20 minutes. Repeat as needed during the first few days at home.
- Keep your arm elevated above your heart for 24 to 48 hours after surgery.
- Take pain medicine as directed.
- Don’t drive until your doctor approves it. Never drive while you are taking opioid pain medicine.
What should I expect while recovering?
Recovery time will depend on the amount of damage there was to the median nerve. Most people notice immediate relief, but symptoms may remain, depending on your condition prior to surgery.
Ask your doctor when you can return to work. If your job requires heavy lifting, you may not be able to begin working again for several weeks.
Possible physical therapy exercises
You may have to undergo physical therapy, but it is more likely you can manage on your own by following the exercise instructions you will be given.