Carpal tunnel syndrome surgery

Carpal tunnel surgery is an operation to relieve the symptoms of carpal tunnel syndrome (CTS) by cutting a ligament in your wrist. The ligament runs across the top of your wrist bones and creates a narrow channel in your wrist. This channel is called the carpal tunnel and inside it are tendons and the median nerve which controls some of the movement in your hand.

In CTS, swelling inside the wrist puts pressure on the median nerve. This causes symptoms such as pain or aching in the hand, fingers, and forearm. Other symptoms include pins and needles, a tingling sensation, numbness in the fingers and a weakened grip. By cutting through the ligament, the pressure is released and the symptoms often go away.

There is no single cause for CTS, but you’re more at risk of getting it if you:

• Are overweight
• Are pregnant
• Have a job that requires you to repeatedly bend your wrist or grip objects hard
• Have another condition that can cause water retention, for example, diabetes or obesity
• Have arthritis
• Have previously fractured or dislocated your wrist
• Have family members with CTS

Sometimes CTS gets better on its own after a few months.

If it doesn’t, there’s a risk that your median nerve could be permanently damaged.

Your doctor may suggest carpal tunnel surgery, but usually after you’ve tried other non-surgical treatments, such as painkillers, exercise, cold packs, shaking your hand vigorously and wrist splints, which haven’t helped. Lifestyle changes may also improve your condition, like taking breaks regularly to rest your hands and avoiding activities that worsen the symptoms.

They’ll also want to know if your symptoms are affecting your daily life or interrupting your sleep. Carpal tunnel surgery has a high success rate in reducing the painful symptoms of CTS and improving quality of life. Your consultant will help you decide if surgery is likely to benefit you.

Carpal tunnel surgery is a quick procedure in which your surgeon opens the carpal tunnel and cuts your transverse carpal ligament. This ligament sits across the front of your wrist and connects the small bones in your wrist, helping to form your carpal tunnel.

Cutting the ligament creates more room in your carpal tunnel and reduces pressure on your median nerve (decompression).

The operation is usually carried out under local anaesthetic, so you’re awake but can’t feel anything in your hand.

Carpal tunnel surgery can be done using open or keyhole surgery. Open surgery involves making one incision (cut) in your wrist, so the surgeon can open the carpal tunnel and cut the ligament.

Keyhole surgery means having a smaller incision and inserting a thin, flexible telescope (an endoscope) to see inside the wrist. Your surgeon cuts your ligament using a special instrument attached to the endoscope.

Your consultant will advise you on which technique is best for you.

How long does carpal tunnel surgery take?

The procedure will take about 20 minutes once your anaesthetic has taken effect.

Anaesthetic choices

The surgery is usually carried out under local anaesthetic. This means you’ll be awake during the procedure but can’t feel anything in your hand. Your consultant will recommend the best option for you, taking into account your wishes.

Pain after carpal tunnel surgery

As with any surgery, you’re likely to feel discomfort once the anaesthetic wears off. But don’t worry – you’ll be given painkillers to help you manage this in the following days.

Your hospital stay

You’ll be able to go home on the same day and won’t need to stay in hospital overnight. You’ll be given your follow-up appointment details before you leave, this will be around two weeks after the surgery.

After your carpal tunnel surgery

It normally takes a couple of hours for the local anaesthetic to fully wear off, after which you should have full sensation in your wrist again. When possible, you should keep your arm elevated and occasionally clench your fingers to help prevent stiffness and swelling. The dressing around your wound should be kept clean and dry, so when bathing you should wrap your wrist in a plastic bag. You can eat and drink as normal after the procedure.

Everyone’s different, so how long it takes to recover from your surgery will depend on your general health and how severe your CTS is.

You’ll be able to leave the hospital on the same day as your surgery and can expect to be able to move your fingers within one or two days. The stitches around your wrist may be dissolvable and disappear within a week or so, if not, your stitches can be removed between three to 14 days after your surgery. Speak to your surgeon or physiotherapist about returning to work; depending on your job, you may be able to go back to work gently after around three weeks.

You can look forward to getting back to everyday activities in a month or so, but it can take up to three months to regain full strength in your hand.

It's entirely normal to experience the following in the days and weeks after carpal tunnel surgery:

• Pain around the incision
• Pain when using, or putting pressure on your hand
• Stiffness
• Swelling
• Tender, lumpy, pink scarring
• Weakness in your grip

These symptoms should improve over time, and most people find the pain caused by their CTS disappears.

Your lifestyle after treatment

You won’t be able to drive after your surgery, so you’ll need to arrange transport home. Before you go, our nursing team will advise you on how to take care of your hand as it heals. Tips include:

• Keeping your hand dry until your stitches have been removed
• Keeping your hand up when you aren’t using it
• Keeping your hand mobile by light activities, such as cleaning your teeth or brushing your hair

You should speak to your motor insurance provider about your surgery, checking your policy, before driving again. If you’re still on painkillers, it's important that you’re free of the sedative effects they may be having. Without driving, you should test how comfortable you are in the driving position, particularly focusing on how comfortable you can operate the steering wheel and perform an emergency stop.

Most people have carpal tunnel surgery without complications, but all surgery carries some risks, and your consultant will explain them to you before you go ahead.

Although rare, carpal tunnel surgery complications can include:

• Injury to the median nerve or other nerves
• Permanent tenderness around the scar
• Weakness or numbness in your hand
• Bowstringing of your tendons – they pop up when the tendon is flexed or extended
• Complex regional pain syndrome – a chronic condition where the hand can become painful, swollen and sensitive to touch
• Recurrence of carpal tunnel syndrome
• Stiffness and swelling around the wound

At Spire hospitals, your safety is our top priority. We have high standards of quality control, equipment and cleanliness and a rigorous system of review and training for our medical teams.