What is carpal tunnel surgery?

Carpal tunnel surgery reduces the pressure on a nerve in the wrist. Your doctor will cut a ligament that presses on the nerve. This lets the nerve pass freely through the tunnel without being squeezed. This is also called carpal tunnel release surgery.

The surgery can be open or endoscopic. In open surgery, your doctor makes a small cut in the palm of your hand. This cut is called an incision. In endoscopic surgery, your doctor makes one small incision in the wrist. Or you may have one small incision in the wrist and one in the palm. Your doctor puts a thin tube with a camera attached (endoscope) into the incision. Surgical tools are put in along with the endoscope.

In both types of surgeries, the incisions are closed with stitches. The incisions leave scars that usually fade in time.

You may be asleep during the surgery. Or you may be awake and have medicine to numb your hand and arm so you won't feel pain.

After surgery, your wrist and hand pain should start to go away. It usually takes 3 to 4 months to recover and 1 year before your hand strength returns. How much hand strength returns is different for each person.

You will go home the same day as the surgery. When you can go back to work depends on the type of work you do.

Surgery may be an option when other treatment hasn't helped, if you've had carpal tunnel syndrome for a long time, or if there's nerve damage or the risk of nerve damage.

The most common surgery for relieving carpal tunnel symptoms involves cutting the transverse carpal ligament. This helps relieve pressure on the median nerve in the wrist. Two approaches for this surgery are:

• Open carpal tunnel release surgery. This requires a longer recovery time and leaves a larger scar than endoscopic surgery. But there may be less chance of other problems.
• Endoscopic carpal tunnel release surgery. Recovery is quicker than with open surgery. But there may be a slightly higher chance of needing another surgery.

Some surgeons are now doing small- or mini-open release surgery. This requires a smaller incision than standard open surgery. It may reduce healing time and scarring. The surgeon can view the ligament directly to minimize danger to the nerve.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk.
• For up to 2 weeks after surgery, avoid lifting things heavier than 1 to 2 pounds and using your hand. This includes doing repeated arm or hand movements, such as typing or using a computer mouse, washing windows, vacuuming, or chopping food. Do not use power tools, and avoid activities that cause vibration.
• You may do heavier tasks about 4 weeks after surgery. These include vacuuming, mowing the lawn, and gardening.
• You may shower 24 to 48 hours after surgery, if your doctor okays it. Keep your bandage dry by taping a sheet of plastic to cover it. If you have a splint, keep it dry. Your doctor will tell you if you can remove it when you shower. Be careful not to put the splint on too tight. Do not take a bath until the incision heals, or until your doctor tells you it is okay.
• You may drive when you are fully able to use your hand.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, take an over-the-counter medicine such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
  • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision and splint care

• Keep your bandage dry. If it gets dirty, you may change it.
• If you have a splint, talk to your doctor about when you should wear it.

Exercise

• You may need wrist and hand rehabilitation. This is a series of exercises you do after your surgery. This helps you get back your wrist's and hand's range of motion, strength, and grip. You will work with your doctor and physical or occupational therapist to plan this exercise program. To get the best results, you need to do the exercises correctly and as often and as long as your doctor tells you.

Ice and elevation

• Put ice or a cold pack on your wrist for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake) or until the swelling goes down. Put a thin cloth between the ice and your skin.
• Prop up the sore wrist on a pillow when you ice it or anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This will help reduce swelling.

Other instructions

• Avoid letting your hand hang down. This can cause swelling.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Carpal tunnel reduces the pressure on a nerve in the wrist. Your doctor cut a ligament that presses on the nerve. This lets the nerve pass freely through the tunnel without being squeezed.

Your hand will hurt and may feel weak with some numbness. This usually goes away in a few days, but it may take several months. Your doctor may remove the large bandage, or the doctor will tell you when and how to remove it yourself. In some cases, you may have a splint. If you have one, you will wear it for about 2 weeks.

Your doctor will take out your stitches in 1 to 2 weeks. Your hand and wrist may feel worse than they used to feel. But the pain should start to go away. It usually takes 3 to 4 months to recover and up to 1 year before hand strength returns. How much strength returns will vary.

The timing of your return to work depends on the type of surgery you had, whether the surgery was on your dominant hand (the hand you use most), and your work activities.

If you had open surgery on your dominant hand and you do repeated actions at work, you may be able to go back to work in 6 to 8 weeks. Repeated motions include typing or assembly-line work. If the surgery was on the other hand and you don't do repeated actions at work, you may be able to return to work in 7 to 14 days.

If you had endoscopic surgery, you may be able to go back to work sooner than with open surgery.

Most people with carpal tunnel syndrome are treated without surgery. Surgery is considered only when:

• Symptoms haven't improved after several weeks to months of nonsurgical treatment. This assumes that you keep having symptoms but there's no sign of nerve damage. Nerve damage would make surgery more urgent.
• Severe symptoms restrict your normal daily activities. For example:
  • You keep having loss of feeling or coordination in your fingers or hand.
  • You have decreased strength in your thumb.
  • Your sleep is severely disrupted by pain.
• There is damage to the median nerve or a risk of damage to the nerve. Damage may be shown by nerve test results and loss of hand, thumb, or finger function.

Nerve tests are often completed before surgery is done. Surgery is more likely to be successful if the results from nerve testing point to carpal tunnel syndrome.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take about 15 to 60 minutes.