Surgery for Carpal Tunnel Syndrome

Surgery for carpal tunnel syndrome, called carpal tunnel release or carpal tunnel decompression, is considered relatively simple and low-risk.

Carpal tunnel release is usually not recommended until patients have undergone at least six months of initial treatments such as rest, splinting, or steroid injections. Some patients may be referred for surgery earlier if they have a case of acute carpal tunnel syndrome with sudden onset, or if the damage to the carpal tunnel and median nerve is already significant.

The goal of carpal tunnel release surgery is to relieve pressure on the median nerve by severing the transverse carpal ligament, which runs lengthwise across the top of the carpal tunnel. Sometimes the ligament heals and reconnects after surgery, but symptoms usually do not recur because the carpal tunnel heals with more space than it had before.

See All About Carpal Tunnel Release Surgery

Two Surgical Approaches for Carpal Tunnel Release

For the procedure, the surgeon will use a local anesthetic to numb the surgical area; general anesthesia is usually not necessary.

There are two approaches that can be used for carpal tunnel release surgery:

1. Open approach. This is the traditional approach in which the surgeon makes a single 2-inch incision in the wrist starting at the base of the palm.
2. Endoscopic approach. This approach involves two smaller incisions and the guidance of a small camera (endoscope) for the surgeon to view the operative area.

See 6 Myths and Truths About Carpal Tunnel Syndrome

A systematic review of the approaches for carpal tunnel release found that both approaches are effective. There was also no evidence that complications were more or less likely to occur from using either approach.¹Huisstede BM, Randsdorp MS, Coert JH, Glerum S, Van middelkoop M, Koes BW. Carpal tunnel syndrome. Part II: effectiveness of surgical treatments--a systematic review. Arch Phys Med Rehabil. 2010;91(7):1005-24. It should be noted that the endoscopic approach may offer one advantage: shorter healing time because of the smaller incisions.

The Risk for Complications Is Low

The risks for complications from carpal tunnel release are low and may include:

• Bleeding
• Infection
• Scar tenderness

In rare cases, there may be damage to the median nerve or other nearby soft tissues. This type of damage may result in weakness or numbness in the hand. Nerve damage occurs in less than 1% of cases.²Benson LS, Bare AA, Nagle DJ, Harder VS, Williams CS, Visotsky JL. Complications of endoscopic and open carpal tunnel release. Arthroscopy. 2006;22(9):919-24, 924.e1-2.

Carpal tunnel release is an outpatient procedure, so patients will go home shortly after the procedure is complete. Once the procedure is done, stitches will be used to close the wound(s) and the wrist will be bandaged.

See Recovering from Carpal Tunnel Release Surgery

A small number of recipients will have a recurrence of hand pain and numbness as the transverse carpal ligament grows back, in which case patients may be referred for a carpal tunnel release revision procedure.

See Recovery Milestones for Carpal Tunnel Release Surgery