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 tightly
• Have another condition that can cause water retention eg diabetes or obesity
• Have arthritis
• Have previously fractured or dislocated your wrist

You’re also at greater risk of CTS if your family members have it. 

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 only after you’ve tried other non-surgical treatments. 

Non-surgical carpal tunnel treatments

Non-surgical treatments for CTS include: 

• Applying cold packs
• Performing yoga and wrist exercises (eg wrist extension, wrist flexion, wrist lift, median nerve glide and hand squeezes) to strengthen your wrist muscles — conversely, exercises that overextend your wrist should be avoided
• Shaking your hand vigorously 
• Steroid injections to reduce inflammation — steroid injections can usually only be given two times in a year 
• Taking anti-inflammatory painkillers to reduce inflammation 
• Wearing wrist splints at night to keep your wrist in a neutral position

Lifestyle changes may also improve your condition, such as taking breaks regularly to rest your hands and avoiding activities that worsen your symptoms.

If you also have arthritis, specifically gout and rheumatoid arthritis, treating these conditions can reduce the swelling and pain caused by your CTS. 

If these non-surgical treatments do not work and your CTS symptoms are affecting your daily life or interrupting your sleep, your doctor may then recommend carpal tunnel surgery. This surgery has a high success rate in reducing the painful symptoms of CTS and improving quality of life. Your doctor 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 — this is called decompression.

The surgery 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 carpal tunnel surgery

Open surgery involves making one cut in your wrist so the surgeon can open the carpal tunnel and cut the ligament.

Keyhole (endoscopic) carpal tunnel surgery

Keyhole surgery uses a smaller cut through which a thin, flexible telescope (an endoscope) is inserted to see inside your wrist. Your surgeon cuts your ligament using a special instrument attached to the endoscope.

Your doctor 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 doctor will recommend the best option for you, taking into account your wishes.

Carpal tunnel syndrome surgery procedure

• You will lie on your back with your arm outstretched by your side on an operating board
• A tourniquet will usually be wrapped around the top of your arm and inflated — this will stop the blood flow down your arm during your surgery, which will reduce bleeding
• A local anaesthetic will be injected into your wrist to numb it 
• Your surgeon will check that the local anaesthetic is working before they start the surgery — you may still feel some pressure but you shouldn't feel any pain; if you start to feel any pain during your surgery, tell your surgeon so they can give you another local anaesthetic injection
• Your surgeon will make a cut below your palm and cut your transverse carpal ligament to release the pressure on your median nerve
• Once the surgery is complete, your surgeon will stitch together the cut and apply a sterile dressing

Pain after carpal tunnel surgery

As with any surgery, you’re likely to feel discomfort once the anaesthetic wears off. But 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 recovery is different. How long it takes to recover from your surgery will depend on your general health and how severe your CTS is.

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

• Pain around the wound and/or pain when using, or putting pressure on your hand — taking over-the-counter painkillers (eg paracetamol, ibuprofen) will help manage your pain; read the patient information leaflet and/or talk to your pharmacist before taking any painkillers
• 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.

Pain after carpal tunnel surgery

Recovery one–two days after surgery

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 in one or two days. 

Recovery one-two weeks after surgery

The stitches around your wrist may be dissolvable and disappear in a week or so. If not, your stitches can be removed between three to 14 days after your surgery. 

Recovery three–four weeks after 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.

Recovery one–three months after surgery 

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.

Carpal tunnel surgery aftercare

Before you leave hospital, your nursing team will advise you on how to take care of your hand as it heals. You will need to start moving your hand, as advised, as soon as possible after your surgery to reduce swelling and stiffness. Our nursing team will advise you to:

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

Hand exercises

Hand exercises are an important part of recovery. However, you should always follow the advice of your surgeon and/or physiotherapist to ensure you don’t overdo it or perform exercises incorrectly and injure your wrist. 

Exercises to help strengthen your wrist include: 

• Bending your wrist up and down — repeat this 10 times
• Making a fist by bringing your fingers in towards your palm and then straightening them back out — repeat this 10 times
• Putting both of your hands together with your palms touching (in a prayer position) and then extending your elbows outwards — you should feel a gentle stretching of your wrist
• Touching the tip of each of your fingers with your thumb

Returning to work 

When you can return to work will depend on your recovery, how you are feeling and what type of work you do. You may be able to return to work after just 12 days. However, most people return to work after around 19 days of recovery post-surgery. 

When you return to work, avoid or limit tasks that put a strain on your wrist, such as typing, lifting heavy objects or holding the phone up to take a call. 

Driving after carpal tunnel surgery 

You won’t be able to drive after your surgery, so you’ll need to arrange transport home. 

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 comfortably you can operate the steering wheel and perform an emergency stop.

Carpal tunnel surgery recovery timeline

Everyone’s recovery is different. However, most people can leave hospital on the same day of their surgery. After one to two days, you will likely be able to wiggle your fingers. 

Three to 14 days after surgery, your stitches will be removed, unless they are dissolvable, in which case they will disappear in the first week. 

Depending on your type of work, you may be able to return two to three weeks after your surgery. You will still need to avoid tasks that put excess strain on your wrist, such as lifting heavy objects and typing. 

You should be able to return to most of your usual activities after a month and expect a full recovery after about three months. 

Most people have carpal tunnel surgery without complications but all surgery carries some risks. Your doctor will explain them to you before you go ahead with surgery.

Although rare, carpal tunnel surgery complications can include:

• Bowstringing of your tendons — tendons that pop up when they are flexed or extended
• Complex regional pain syndrome — a chronic (long-term) condition where your hand becomes painful, swollen and sensitive to touch
• Discomfort, pain or tenderness around the scar — this can take several months to go away
• Injury to the median nerve or other nerves
• Stiffness and swelling around the wound — elevating your hand should help reduce swelling
• Weakness or numbness in your hand — this usually gets better once you have completely recovered from your surgery, which can take several months

Your CTS may also recur. 

At Spire Healthcare 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.