What is Carpal Tunnel Syndrome?

The median nerve and several tendons run from the forearm to the hand through a small space in the wrist called the carpal tunnel. The median nerve controls movement and sensation in the thumb and first 3 fingers. Repetitive hand movements, wrist trauma or inflammation from conditions like rheumatoid arthritis or diabetes can result in swelling causing compression of the median nerve that results in tingling, numbness, pain and weakness in the hand, thumb, and first three fingers that is known as carpal tunnel syndrome. Mild-to-moderate carpal tunnel syndrome can be treated non-surgically. But if symptoms are severe or keep coming back, your physician may recommend a surgical procedure called carpal tunnel release.

Baptist Health is nationally recognized for excellence in treating carpal tunnel syndrome. We offer a full spectrum of orthopedic care and the latest approaches to carpal tunnel treatment. Best of all, you will appreciate convenient appointment times, locations near you and a personalized focus to meet your needs before, during and after your procedure.

Non-surgical Treatment

Mild symptoms usually can be treated with home care. You can:

• Stop activities that cause or increase numbness and pain
• Rest the wrist longer between activities
• Ice wrist for 10 to 15 minutes 1 or 2 times an hour during an acute flair
• Nonsteroidal anti-inflammatory medications (such as Aleve or Motrin) can help relieve pain and reduce swelling
• An injection of a corticosteroid medication may be given to decrease inflammation
• Wear a wrist splint at night. This takes pressure off of the median nerve. The splint should fit like a sleeve and stabilizes the wrist

What is Carpal Tunnel Release?

Carpal tunnel release is a surgical procedure to cut the ligament that forms the roof of the carpal tunnel, to increase the size of the tunnel and relieve pressure on the median nerve. There are two surgical techniques the surgeon may use – open carpal tunnel release or endoscopic carpal tunnel release. Both are effective in treating carpal tunnel syndrome. 

What Can Carpal Tunnel Release Accomplish?

If symptoms of carpal tunnel syndrome do not resolve after nonsurgical treatment, a carpal tunnel release procedure may be recommended to:

• Relieve pain and numbness in the hand, wrist or fingers
• Treat weakness and enhance grip- and pinch-strength

What Can I Expect During the Procedure?

Most carpal tunnel release surgeries are performed on an outpatient basis. Nerve blocks to numb the forearm/hand or general anesthesia will be used during surgery. The nerve blocks are given with a light sedative to promote relaxation and sleep during the surgery. The surgery will take less than one hour.

Open Carpal Tunnel Release

During open carpal tunnel release surgery, the surgeon makes a small incision in the palm and views the inside of the hand and wrist through this incision. The surgeon then divides the transverse carpal ligament (roof of the carpal tunnel), to increase the size of the tunnel and reduce pressure on the median nerve. The ligament may gradually grow back together post-surgery, but there will be more space in the carpal tunnel.

Endoscopic Carpal Tunnel Release

In endoscopic carpal tunnel release surgery, the surgeon makes one or two smaller skin incisions, known as portals, and inserts a thin instrument equipped with a miniature camera – called an endoscope – which projects images onto a monitor. Viewing images of the inside of the wrist and hand on the monitor, the surgeon uses a small, specialized knife to divide the transverse carpal ligament, similar to the open procedure.

Recovery

Right after surgery, the surgeon and nurses will encourage elevation of the hand above the level of the heart and movement of the fingers to reduce swelling and prevent stiffness. Some pain, swelling and stiffness is normal after the procedure, and mild soreness in the palm may last for several weeks to several months.

A wrist splint or brace will be utilized for a few weeks. Use of the operative hand is encouraged, but not to the point of discomfort. Most people can resume driving, grooming and dressing, and activities that involve light lifting and gripping soon after surgery. The surgeon will give instructions on when to return to work and any needed activity modifications or restrictions.

Estimated Recovery Timeline

Recovery from carpal tunnel surgery varies from patient to patient, taking anywhere from several weeks to several months. The longer the median nerve was compressed, the longer recovery typically takes. Grip and pinch strength usually return within a few months after surgery, but if the nerve was severely compressed, it may take six to 12 months.

If significant pain and/or weakness lasts for more than two months after surgery, the physician may refer the patient to a hand therapist to help speed the recovery.

Carpal Tunnel Release Possible Risks

Any surgery carries risks, but carpal tunnel release is typically a safe and effective procedure. Instructions will be given instructions about how to avoid specific risks, as well as what to do if any of the following symptoms should occur after the procedure.

• Bleeding
• Infection
• Nerve irritation or injury resulting in pain or decrease in sensation and mobility