Carpal Tunnel Syndrome Surgery

What is Carpal Tunnel Syndrome?

There are three main nerves travelling down the arm to the hand. One of these, the median nerve, is responsible for most feeling in the hand (apart from the little finger). The median nerve travels through a narrow tunnel, the carpal tunnel, as it passes from the wrist into the palm of the hand. If the carpal tunnel becomes too narrow, then pressure on the nerve develops and the symptoms of carpal tunnel syndrome appear. Learn more about Carpal Tunnel Syndrome in the "Anatomy and Causes" section of this web site.

Why is Surgery Done?

Open carpal tunnel surgery is considered when:

• Symptoms are still present after a long period of nonsurgical treatment. Some experts recommend that surgery not be considered until after at least a year of nonsurgical treatment.
• Severe symptoms (such as persistent loss of feeling or coordination in the fingers or hand, or no strength in the thumb) restrict normal daily activities.
• There is damage to the median nerve (shown by nerve test results and loss of hand or finger function), or a risk of nerve damage.
• Tumours or other growths need to be removed.

The Operation

During open carpal tunnel release surgery, the transverse carpal ligament is cut, which releases pressure on the median nerve and relieves the symptoms of carpal tunnel syndrome. An incision is made at the base of the palm of the hand. This allows the doctor to see the transverse carpal ligament. After the ligament is cut, the skin is closed with stitches. The gap where the ligament was cut is left alone and eventually fills up with scar tissue. Open carpal tunnel release surgery is usually done under local anaesthetic as an outpatient same-day surgery.

What are the Outcomes?

Most people who have surgery for carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their hand after surgery. The overall success rate for either endoscopic or open surgery is more than 95%. However, after open surgery, recovery may be slower, and there may be some pain in the wrist and hand.

In rare cases, the symptoms of pain and numbness may return (the most common complication), or there may be temporary loss of strength when pinching or gripping an object, due to the cutting of the transverse carpal ligament.

If the thumb muscles have been severely weakened or wasted away, hand strength and function may be limited even after surgery.

What are the Risks?

The risk and complication rates of open surgery are very low (about 5%). There is a small risk that the median nerve or other tissues may be damaged during surgery. There are also the risks of any type of surgery, including possible infection and risks of general anaesthesia. However, most open carpal tunnel surgery is done with local anaesthesia or regional block, rather than general anaesthesia.

Click here to download an Information Sheet on Carpal Tunnel Surgery

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