Carpal Tunnel Release

The carpal tunnel is a narrow passage on the palm side of the wrist. Its floor and sides are formed by the small wrist bones, and its roof is a tough band called the transverse carpal ligament. Through this passage run nine tendons that bend the fingers and thumb, together with the median nerve. When the tissues inside the tunnel swell or the space narrows, the nerve is squeezed, and its signals slow down. Carpal tunnel release is surgery to divide the transverse carpal ligament completely. Once it is cut, the two edges spring slightly apart and the tunnel becomes roomier, so pressure on the nerve falls. Over the following weeks the gap fills with scar tissue, and the tunnel stays larger than before. The operation does not remove anything, and the fingers and wrist keep their normal movement afterwards. It is a routine and widely performed hand operation.

Carpal tunnel syndrome typically causes tingling and numbness in the thumb, index and middle fingers, often worse at night or when holding a phone, steering wheel or book. Many people shake their hand to wake it up. Over time, grip can weaken, small objects become hard to handle and the muscles at the base of the thumb may waste. The condition is more common in women, during pregnancy, and in people with diabetes, an underactive thyroid, rheumatoid arthritis, a previous wrist fracture or work that involves forceful, repetitive gripping or vibrating tools. Mild cases often respond to a wrist splint worn at night, a steroid injection into the tunnel and changes in activity. Surgery is recommended when symptoms persist or keep returning despite these measures, when they are constant rather than intermittent, when nerve conduction studies show moderate or severe compression, or when there is weakness or muscle wasting, which signals the nerve is under significant strain.

Carpal tunnel release is usually done under local anaesthesia, injected into the palm and wrist, so you stay awake but feel no pain. Many surgeons use a technique called wide awake local anaesthesia with no tourniquet, in which an added medicine reduces bleeding and no tight cuff is needed on the arm; others use a tourniquet or a regional block that numbs the whole arm. In open release, the surgeon makes an incision of about 2 to 4 centimetres in the palm, in line with the ring finger, and divides the ligament under direct vision while protecting the nerve. In endoscopic release, a thin camera is passed through one or two small cuts near the wrist crease and the ligament is divided from the inside. The endoscopic approach may allow a slightly faster return of grip and less early scar tenderness, while long-term results of both methods are similar. The skin is closed with a few stitches, a padded dressing applied, and the operation takes about 15 to 30 minutes.

Good candidates have symptoms that fit carpal tunnel syndrome, confirmed by examination and usually by nerve conduction studies, sometimes with an ultrasound scan of the wrist. These tests also help rule out other causes of hand numbness, such as a trapped nerve in the neck or a nerve problem from diabetes, which would not be cured by wrist surgery. You should be well enough for a short procedure; most people with heart, lung or diabetic conditions can still be treated under local anaesthesia. Your medicines are reviewed, and blood thinners are often continued but sometimes adjusted on medical advice. If both hands are affected, the hands are often treated one at a time, a few weeks apart, so you keep one hand free for daily care, although some patients choose to have both done together. For international patients, nerve test results and a description of symptoms can usually be reviewed remotely, so the operation can often be scheduled soon after arrival.

You go home the same day with a bulky dressing and are encouraged to move your fingers fully from the start, which helps the tendons glide and reduces swelling. Keeping the hand raised for the first two to three days eases throbbing. The dressing is usually reduced after two or three days, and stitches are removed after about 10 to 14 days unless dissolving stitches are used. Light everyday tasks such as typing, dressing and eating are usually possible within one to two weeks, while heavy gripping, lifting and pushing up from a chair with that hand may stay uncomfortable for one to three months. Most people return to office work within one to two weeks and to manual work within four to six weeks. For travel, it is usually enough to stay about two to three days, so the first dressing check can be done before the flight. Stitch removal can be done by a nurse or doctor near home, with remote follow-up and a hand therapist if stiffness persists.

Carpal tunnel release is a common, well-established operation with a high rate of symptom relief, but it is still surgery. Expected effects include soreness, swelling and a tender scar for several weeks. Pain on either side of the scar at the base of the palm, called pillar pain, is common and may take a few months to settle. Less common risks include wound infection, bleeding under the skin, stiffness and, rarely, injury to the median nerve or one of its branches, or a pain syndrome called complex regional pain syndrome. Symptoms can occasionally persist if the ligament is not fully divided, or return years later, sometimes needing a second operation. Night pain and tingling often improve within days. In long-standing or severe cases, numbness may take many months to improve and may not recover fully, and wasted thumb muscles may stay weaker, which is why it is sensible not to delay surgery once the nerve shows signs of damage.