Carpal Tunnel Release Surgery

Overview

Carpal tunnel release is a surgical procedure to relieve pressure on the median nerve as it passes through the carpal tunnel at the wrist. By cutting the transverse carpal ligament that forms the roof of the tunnel, the procedure increases the space within the tunnel and reduces compression of the nerve. It is one of the most common hand surgeries performed.

Indications

This procedure may be considered when:

• •Carpal tunnel syndrome with symptoms not adequately controlled by conservative treatment
• •Moderate to severe carpal tunnel syndrome confirmed by nerve conduction studies
• •Progressive numbness, tingling, or weakness in the median nerve distribution
• •Thenar muscle weakness or atrophy (indicating advanced compression)
• •Persistent symptoms despite splinting, corticosteroid injections, and activity modification
• •Nighttime symptoms significantly disrupting sleep

How It Works

The procedure typically involves several coordinated steps:

• •The procedure is typically performed under local anesthesia, sometimes with sedation
• •Open technique: A small incision is made in the palm at the base of the hand
• •The transverse carpal ligament is visualized and carefully divided
• •The median nerve is inspected and released from any surrounding adhesions
• •Endoscopic technique: One or two small incisions are used with camera guidance
• •The ligament is cut using specialized instruments passed through a small cannula
• •Both techniques achieve the same goal of opening the carpal tunnel
• •The skin is closed with sutures, and a soft dressing is applied

Risks

As with any surgical procedure, potential risks include:

• •Incomplete relief of symptoms
• •Pillar pain (tenderness at the sides of the incision)
• •Scar tenderness or sensitivity
• •Injury to the median nerve or its branches
• •Injury to surrounding tendons or blood vessels
• •Infection
• •Stiffness or weakness in the hand
• •Recurrence of symptoms (uncommon)
• •Complex regional pain syndrome (rare)

Recovery Expectations

Recovery follows a gradual progression:

• •Most procedures are performed as outpatient surgery
• •Finger movement is encouraged immediately after surgery
• •The dressing is typically worn for 1 to 2 weeks
• •Sutures are removed around 10 to 14 days after surgery
• •Grip strength may be reduced for several weeks to months
• •Light activities can often resume within days to weeks
• •Full recovery of strength may require 2 to 3 months
• •Numbness and tingling may improve quickly or gradually over months

Alternatives

Depending on individual circumstances, alternatives may include:

• •Wrist splinting, especially at night
• •Activity modification to avoid aggravating positions
• •NSAIDs or other pain relievers
• •Corticosteroid injection into the carpal tunnel
• •Physical or occupational therapy
• •Ergonomic workplace adjustments

Sources

• AAOS OrthoInfo – Carpal Tunnel Syndrome
• Cleveland Clinic – Carpal Tunnel Surgery