Carpal Tunnel Release

What is a carpal tunnel release?

Carpal tunnel release is a surgical procedure used to treat carpal tunnel syndrome (CTS), a condition that causes pain, numbness, and tingling in the hand and fingers. CTS occurs when the median nerve is compressed as it passes through the carpal tunnel, a narrow passageway in the wrist. Carpal tunnel release surgery relieves pressure on the median nerve by cutting the ligament that forms the roof of the carpal tunnel.

Why is carpal tunnel release performed?

Carpal tunnel release is recommended when non-surgical treatments, such as wrist splinting or corticosteroid injections, have not relieved symptoms, or if the condition is severe. CTS can lead to persistent pain, weakness, or loss of function in the hand if left untreated. Surgery is generally recommended in cases where:

• Symptoms are affecting daily activities or quality of life
• Numbness or weakness in the hand is progressing
• Nerve damage is suspected, or muscle wasting in the hand is present
• Non-surgical treatments have not provided lasting relief

Carpal tunnel release is the most effective treatment for long-term relief of CTS symptoms, particularly when performed early, before permanent nerve damage occurs.

Preparing for carpal tunnel release

Before surgery, patients will have a consultation with a hand surgeon to assess the severity of the condition. Tests such as nerve conduction studies or electromyography (EMG) may be performed to confirm the diagnosis and evaluate the extent of any nerve damage. The surgeon will discuss the procedure, risks, and recovery process during this consultation.

Patients may be advised to stop taking certain medications, such as blood thinners, a few days before surgery to reduce the risk of bleeding.

What does the procedure involve?

The surgery is usually performed as a day-case procedure, meaning most patients can go home the same day. Carpal tunnel release is typically performed under local anaesthetic, meaning the patient is awake but the wrist and hand are numbed. There are two main types of carpal tunnel release:

• Open carpal tunnel release – A small incision is made in the palm of the hand, and the surgeon cuts the ligament to release pressure on the median nerve.
• Endoscopic carpal tunnel release – A smaller incision is made, and the surgeon uses a camera (endoscope) to guide the procedure.

Both methods are effective, and the choice of technique depends on the surgeon's preference and the patient’s condition. The procedure typically takes around 20 to 30 minutes.

What are the potential risks and complications?

Carpal tunnel release is a safe and routine procedure, but as with all surgeries, there are potential risks. These include:

• Infection at the surgical site
• Scar tenderness or thickening
• Stiffness or reduced movement in the wrist
• Nerve injury (rare)
• Persistent symptoms or incomplete relief of CTS
• Recurrence of CTS (rare)

The surgeon will discuss these risks before the procedure and provide advice on managing them during recovery.

After the procedure

After the procedure, the wrist may be bandaged, and patients are advised to keep the hand elevated for the first few days to reduce swelling. Mild pain, bruising, and stiffness in the hand are common but can be managed with over-the-counter pain relief. Most patients experience immediate relief from numbness and tingling, though full recovery of hand strength may take a few months.

Patients are usually able to move their fingers soon after surgery to maintain flexibility, but it is recommended to avoid heavy lifting or strenuous activities for at least a few weeks. Physiotherapy exercises may be suggested to help restore strength and range of motion in the hand.

Depending on the patient’s job and activity level, most people can return to work and normal activities within 2 to 6 weeks. It is important to follow the surgeon’s advice on post-operative care to ensure the best recovery outcome.

Carpal tunnel release surgery has a high success rate, with most patients experiencing significant relief from symptoms and improved hand function. Full recovery can take a few months, but most people regain normal hand strength and are able to return to their regular activities.

In some cases, especially if the surgery is delayed, there may be a risk of incomplete recovery if permanent nerve damage has already occurred. Early diagnosis and treatment of carpal tunnel syndrome are key to achieving the best long-term outcomes.