Carpal Tunnel Release

Carpal tunnel release is a surgical procedure that divides the ligament pressing on the median nerve at the wrist, relieving numbness, tingling and weakness caused by carpal tunnel syndrome.

The median nerve passes through a tunnel at the wrist bounded by the carpal bones and roofed by the transverse carpal ligament. Where pressure in that tunnel is persistently raised, the nerve loses its blood supply intermittently, then structurally. Carpal tunnel release divides the transverse carpal ligament so the tunnel can open and the pressure falls. The ligament is not repaired or replaced; the gap fills with scar tissue in a wider position. It is one of the most predictable operations in hand surgery, and its purpose is as much to stop further nerve damage as to relieve symptoms.

Patients with carpal tunnel syndrome confirmed on examination, and where needed on nerve conduction studies, who have not responded adequately to night splinting, activity modification or injection. Surgery is recommended earlier, without working through non-operative options first, where there is constant rather than intermittent numbness, loss of two-point discrimination, or wasting of the thenar muscles at the base of the thumb — these indicate structural nerve damage that will not recover if compression continues. Severe symptoms in pregnancy are usually managed non-operatively first, as they frequently resolve after delivery. Where symptoms are mild and intermittent, non-operative treatment remains reasonable.

The operation is a day case and takes around fifteen minutes. It is usually done under local anaesthetic with you awake, or under a regional block; general anaesthesia is rarely necessary. In the open technique a short incision is made in the palm, the ligament is divided under direct vision, and the nerve is inspected. In the endoscopic technique the ligament is divided through one or two small incisions using a camera. Both divide the same structure and long-term results are equivalent; endoscopic release gives slightly faster early recovery and less scar tenderness, open release gives direct visualisation and is preferred where the anatomy is atypical, where there has been previous surgery, or where anything else in the tunnel needs to be addressed. The skin is closed with sutures and a light dressing applied.

The hand is elevated for the first 48 hours and finger movement starts immediately — full finger flexion and extension from day one prevents stiffness and keeps the nerve gliding. The dressing is reduced after a few days and sutures are removed at ten to fourteen days. Light activity resumes within days; driving is usually possible at one to two weeks once you can grip the wheel safely. Heavy gripping and manual work typically return at four to six weeks. Night symptoms often disappear immediately, which is the change most patients notice first. Numbness improves gradually over weeks to months as the nerve recovers, and grip strength usually takes three months to return fully, sometimes longer. Where the nerve was severely damaged before surgery, some numbness may be permanent.

Scar tenderness and pillar pain — discomfort in the heel of the hand on weight-bearing — are common for the first two to three months and settle in the great majority. Temporary weakness of grip is expected. Infection is uncommon. Incomplete relief occurs where the ligament was not fully divided, where there is a second site of compression along the nerve, or where the diagnosis was not the only problem, and is the usual reason for persistent symptoms. Injury to the median nerve or its palmar cutaneous or motor branches is rare but recognised. Complex regional pain syndrome is rare. The single most important point in consent is this: the operation reliably stops compression, but it cannot reverse nerve damage that has already become permanent, which is why timing matters.