Carpal tunnel release surgery is a procedure to relieve symptoms associated with carpal tunnel syndrome, which involves pressure on the median nerve of the wrist, resulting in pain, numbness and weakness. Carpal tunnel release is one of the most commonly performed surgical procedures in the United States, according to the National Institute of Neurological Disorders and Stroke.
The carpal tunnel is a narrow passageway inside the palm side of the wrist. It encloses the median nerve and nine tendons that bend the fingers. The median nerve supplies sensation to the thumb, the first two fingers, part of the third finger and provides motor function to some of the muscles in the hand. Compression of the median nerve produces the numbness, tingling, pain and hand weakness associated with carpal tunnel syndrome.
Carpal Tunnel Syndrome
Carpal tunnel syndrome that involves mild nerve impairment often can be treated with medication, various therapies and modifications of routines that exacerbate the condition. However, in some cases surgery may be necessary to adequately relieve symptoms associated with this disorder, which may include:
- Tingling and/or numbness of the fingers and/or hand
- Radiating wrist pain
- Weakened grip
- A tendency to drop objects, even if they are not heavy
- Loss of feeling in some of the fingers
- Physicians generally recommend carpal tunnel release surgery for patients who have experienced symptoms of carpal tunnel syndrome for six months or more.
During this procedure, a surgeon severs bands of tissue inside the wrist to reduce pressure on the median nerve. If both hands are affected, patients may require surgery to be performed on both wrists.
Types of carpal tunnel surgery
There are three main types of carpal tunnel release surgery. All are usually performed as outpatient procedures under local anesthesia.
Open release carpal tunnel surgery
This is the traditional surgery used to treat carpal tunnel syndrome. An incision about 2 inches long is made in the wrist, and then the carpal ligament is cut. The technique allows the surgeon a better view of the anatomy and reduces the risks of injury to adjoining structures. It may require a longer recovery time than the other types.
Endoscopic (arthroscopy) carpal tunnel surgery
One or two small incisions are made in the wrist and palm, and a camera attached to a tube (endoscope) is inserted through the openings. This allows the surgeon to observe the structures on a screen while cutting the carpal ligament. The endoscopic procedure minimizes scarring and scar tenderness, and may allow faster recovery of physical function while minimizing postoperative discomfort.
Small palmar incision.
A single, small incision is made in the palm over the carpal ligament. This technique allows for good direct visualization of internal structure and decreases risk of injury to adjoining areas, while avoiding a longer scar at the base of the palm.
Each technique resolves the pressure on the median nerve that results in pain and numbness, but also has particular advantages and disadvantages. The surgeon will usually determine the most appropriate technique for the patient.
Before, during and after the surgery
Prior to surgery, patients are encouraged to strictly follow any preparatory advice suggested by their physician. These may include dietary restrictions and temporary changes to medication regimens.
Carpal tunnel release surgery is usually an outpatient procedure performed under local anesthesia. Depending on the method used during this procedure, the surgeon makes one or two small incisions over the palm and/or wrist. The carpal ligament is located directly below the incisions, just past the wrist in the direction of the fingers. The surgeon cuts this ligament in line with the arm (longitudinally) to enlarge the carpal tunnel and release pressure on the median nerve.
Some surgeons also will surgically remove tissue surrounding the median nerve, especially in cases where the tissue is swollen or irritated.
After the surgery, the wrist typically is immobilized with a splint or heavy bandage for about a week. Patients may be allowed limited use of the wrist within a few days of surgery, but it is usually weeks or months before a physician will approve unrestricted use.
In some cases, patients will experience immediate relief of symptoms after surgery. In other cases, full recovery can take several months. Some patients will undergo occupational therapy or physical therapy to strengthen the wrist and improve function.
Risks with carpal tunnel release
Although carpal tunnel release surgery provides great relief from symptoms for most patients, some will experience negative side effects. These can include infection, nerve damage, stiffness and pain at the scar site.
The majority of patients recover completely after surgery, but some patients may experience loss of strength at the wrist. Occupational therapy or physical therapy, preferably from a certified hand therapist (CHT), can often restore this strength. However, some patients may need to either adjust how they perform their job or change jobs after surgery.
Other risks include those associated with all surgery (such as bleeding or infection) or use of anesthesia (allergic reactions, breathing difficulties).
The prognosis after carpal tunnel release surgery is usually good. Most patients will experience a significant decrease in pain, tingling and numbness. However, the procedure may be less effective in those who have suffered severe damage or who have had carpal tunnel syndrome for a long period of time.
Studies have also found that people who engage in certain behaviors report a lower level of satisfaction with the results of their surgery. Activities that may reduce the effectiveness of carpal tunnel release include:
- Consuming more than two alcoholic drinks a day
- Being exposed to repetitive, forceful activities
- Patients with poor mental or physical health prior to surgery may also experience less-than-desirable results.
Recurrence of carpal tunnel syndrome after surgical treatment is rare.
Carpal Tunnel Release Surgery Recovery time
Normal recovery takes 3 to 4 weeks without any risk factors. However, diabetes, smoking, infection etc can delay the recovery time considerably.
Questions for your doctor about surgery
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about carpal tunnel release surgery:
- Can any noninvasive treatments for carpal tunnel syndrome allow me to avoid carpal tunnel release?
- Why is surgery the best option for me?
- Which type of carpal tunnel release is recommended for me?
- How experienced is my surgeon in this type of procedure?
- What type of anesthetic will I have?
- Do I need to fast, discontinue any medications or do anything else to prepare?
- What are the risks of surgery for me?
- Will I have to stay in the hospital overnight after surgery? Will I need to arrange a ride home?
- How long is my expected recovery period?
- What is my prognosis?
- Will I benefit from hand therapy after my surgery? If so, can you recommend a therapist or facility?
- Is there much chance I will experience carpal tunnel syndrome again after the operation?
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