If nonsurgical treatment does not relieve your symptoms or you have significant pain and numbness in the hand, your doctor may recommend surgery. In long-standing cases with constant numbness and wasting of your thumb muscles (atrophy), surgery may be recommended to prevent irreversible damage.

Carpal  Tunnel Release

The surgical procedure performed for carpal tunnel syndrome is called a "carpal tunnel release." There are two different carpal tunnel release techniques: open and endoscopic.

Open carpal tunnel release

• Most common
• 5-10 minute long procedure
• Performed under local anesthesia.
• 2-4 centimeter incision in the middle of the palm
• Divide the transverse carpal ligament (the “roof” of the carpal tunnel). By dividing the “roof”, the space within the tunnel increases and the pressure on the median nerve is reduced.
• Incisions are closed with sutures

Endoscopic carpal tunnel release

• One or two smaller skin incisions (portals)
• A miniature camera (endoscope) is used to see inside your hand and wrist.
• A special knife is used to divide the transverse carpal ligament, similar to the open carpal tunnel release procedure.
• Incisions are closed with sutures

Goal

• Relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel. This increases the size of the tunnel and decreases pressure on the median nerve.

Who qualifies?

• Patients with significant pain, numbness, and/or atrophy.
• Patients whose symptoms were not relieve from nonsurgical treatment methods.

Recovery

• Soft dressing to cover the sutures after surgery.
• Sutures are removed 7-10 days following the procedure.
• Minor soreness in the palm could last for several weeks to months
• Grip strength usually returns in 2 to 3 months depending on the condition of the median nerve pre-surgery.
• Splint/brace for several weeks
• Physical therapy may be recommended for functional return.

Recovery times may be slower if you have

• Arthritis or tendonitis
• Long-standing cases of carpal tunnel syndrome with severe loss of feeling and/or muscle wasting around the base of the thumb. For these patients, a complete recovery may not be possible.

Complications: Similar to the majority of procedures, the most common complications of carpal tunnel release surgery include

• Bleeding
• Infection
• Nerve aggravation or injury

Outcomes

• The outcomes of open surgery and endoscopic surgery are similar, and for most patients, surgery is very effective in improving the symptoms of carpal tunnel syndrome.
• Although rare, carpal tunnel syndrome can recur. In this case, you may need additional treatment or surgery.