Carpal Tunnel Release Surgery
Also known as: median nerve decompression or carpal tunnel decompression
If your symptoms are worsening and other treatments have proven ineffective, especially if you are experiencing more severe symptoms, it might be time to consider carpal tunnel release surgery.
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a prevalent condition caused by increased pressure on the median nerve as it travels through a narrow passageway at the front of the wrist, resulting in irritation. This can lead to symptoms including numbness, tingling, weakness, or pain in the hand and fingers, particularly involving the thumb, index, middle, and part of the ring finger.
Symptoms & diagnosis
When diagnosing carpal tunnel syndrome, healthcare professionals evaluate various symptoms. These symptoms may fluctuate over time and are often more pronounced at night or upon waking. In more severe cases, symptoms can persist continuously, both day and night, and may be triggered by specific activities like holding a phone or reading.
The typical symptoms include:
- An aching or painful sensation in the fingers, hand, or sometimes the arm
- Numbness in the hand
- Burning, tingling, or a pins-and-needles sensation in the fingers, usually affecting the thumb, index, middle, and ring fingers
- Weakness in the hand or a tendency to drop objects
Causes and risk factors
In most patients, the cause of CTS is not clear. However, you’re more at risk if you:
- Have diabetes, a low thyroid condition or arthritis in the wrist
- Are pregnant
- Have had a recent wrist injury
- Have rheumatoid arthritis, as it may contribute to carpal tunnel syndrome
Long-term consequences of untreated carpal tunnel syndrome
Untreated Carpal Tunnel Syndrome (CTS) can lead to significant long-term consequences, including permanent nerve damage, which may cause persistent numbness, tingling, and pain in the hand and fingers. Over time, the muscles in the hand, particularly the thenar muscles controlling the thumb, may weaken, leading to a loss of grip strength, dexterity, and fine motor skills. Prolonged compression of the median nerve can result in muscle atrophy at the base of the thumb, causing deformity and reduced hand function. Chronic pain can develop, radiating from the hand to the wrist, forearm, or shoulder, further impairing daily activities such as typing, cooking, or driving. Additionally, compensating for weakened or painful hands may strain other joints and muscles, potentially leading to secondary problems in the elbow, shoulder, or opposite hand. These complications can significantly diminish quality of life, emphasising the importance of early diagnosis and treatment to prevent permanent damage.
Non-surgical treatment for carpal tunnel syndrome
Carpal Tunnel Syndrome can often be managed without surgery, especially in its milder stages. Treatment options include avoiding activities that trigger symptoms, wearing a wrist splint at night to keep the wrist in a neutral position, and receiving corticosteroid injections. These injections, administered by a specialist in an outpatient setting, take only a few minutes and can provide significant symptom relief. However, while effective initially, symptoms may return over time despite a good early response to the injection.
Hospital fee guide price: £1,476
Procedure price subject to bespoke quotation
*Additional consultant fee not included
Before the surgery
Consultation
Initially, you will attend a consultation with one of our orthopaedic surgeons. During this appointment, the doctor will assess the sensation in your fingers and the strength of your hand muscles. They may also evaluate the nerve by bending the wrist, tapping, or applying pressure to aid in diagnosing carpal tunnel syndrome.
Your doctor might suggest a nerve conduction study, although it’s not always necessary. This test measures the small electrical impulses generated by your nerves and muscles, helping to diagnose carpal tunnel syndrome and rule out other conditions.
Pre-admission process
You may be asked to attend a pre-admission consultation before your surgery, to best prepare you for the operation.
During this consultation, your doctor will review any medications (including over-the-counter drugs and supplements) you are currently taking. You may be advised to stop taking certain medications, such as aspirin or ibuprofen, blood thinning medication or supplements in the weeks leading up to your surgery. Additionally, you’ll need to stop smoking, as it increases the risk of complications, like infection.
Your doctor may also perform tests, such as blood tests, X-Rays, ultrasound, or an electrocardiogram (ECG), to evaluate your overall fitness for the surgery. If you have specific health concerns, further tests might be required.
At this appointment, you will receive important information, including:
- Instructions on what to eat and drink before your procedure (e.g., fasting for six hours, depending on the type of anaesthetic used)
- An estimated timeline for your full recovery
- Guidance on any medications you should start or stop before surgery
- What to expect after your carpal tunnel release surgery
Your expert will also discuss the potential risks of the surgery and answer any questions you may have. Finally, you will be asked to sign a consent form to confirm your agreement to proceed with the carpal tunnel release surgery.
During the surgery
If your symptoms are worsening and other treatments have proven ineffective, especially if you are experiencing more severe symptoms, it might be time to consider carpal tunnel release surgery.
This straightforward procedure typically lasts between 10 to 20 minutes and is generally performed under local anaesthesia. This means your hand will be numb, but you will remain awake during the operation. In some cases, your surgeon may discuss the option of undergoing the surgery while you are asleep. You’ll be admitted to the hospital and discharged on the same day.
There are several types of carpal tunnel release surgeries, each with its own approach to relieving pressure on the median nerve:
- Open Carpal Tunnel Release: This is the most common type of surgery. A single incision is made in the wrist to access the carpal tunnel and release the compressed median nerve. This method provides a direct view of the transverse carpal ligament, allowing for precise cutting.
- Endoscopic Carpal Tunnel Release: This minimally invasive procedure involves inserting a small camera and surgical instruments through two small incisions in the wrist. The camera provides a view of the carpal tunnel on a monitor, guiding the surgeon as they release the compressed median nerve. This method typically results in a quicker recovery and less post-operative pain.
- Mini-Open Carpal Tunnel Release: This is a variation of the open carpal tunnel release, where a smaller incision is made in the wrist. It combines the benefits of both open and endoscopic techniques, offering a balance between direct visualisation and minimal invasiveness.
Each type of carpal tunnel release has its own advantages and considerations. Your surgeon will help determine the best approach based on your specific condition and needs.
After the nerve has been released, your skin will be closed with stitches and a dressing and bulky bandage is applied.
Once you’re in the recovery ward and the anaesthetic wears off, you’ll be able to go home.
After the surgery
During recovery, most patients will need to wear the bulky bandage for a few days to a week. After this period, a smaller dressing can be applied to the wound. It is important to avoid heavy lifting and keep the wound dry for at least two weeks post-surgery. While the pain is typically mild, over-the-counter pain relievers may be necessary for a few days.
Light exercises may be recommended to prevent finger stiffness. Full recovery to normal activities can take up to three months. The pins and needles sensation associated with carpal tunnel syndrome often subsides within a few weeks after surgery, while numbness in the fingers may take several months to a year to resolve.
If your job involves desk work or manual labour, such as driving or frequent hand use, exercise caution when using the hand during the first two weeks. Light daily activities and work are usually manageable, but heavy lifting should be avoided for two weeks following the surgery.
It is recommended you avoid driving for at least seven to ten days following surgery. Make sure to consult with your doctor to determine the appropriate time to resume driving and ensure you feel confident and safe behind the wheel.
For those who engage in sports, it’s advisable to avoid strenuous exercises for the first ten days and refrain from heavy lifting for a longer period. Always seek guidance from your doctor.
If you experience severe symptoms, particularly those persisting after surgery, it is crucial to re-evaluate your condition with your doctor. Severe symptoms can affect your recovery time and treatment outcomes, so timely medical advice is essential.
Risks and Complications
As with any surgical procedure, carpal tunnel surgery carries some risks and potential complications. It’s essential to be aware of these before deciding to undergo the procedure:
- Infection: As with any surgery, there is a risk of infection at the incision site.
- Nerve Damage: There is a risk of damaging the median nerve or other nerves in the wrist during surgery.
- Scarring: Carpal tunnel surgery can result in scarring, which may be permanent.
- Wrist Stiffness: Some patients may experience stiffness or a limited range of motion in the wrist after surgery.
- Recurrence: In some cases, carpal tunnel syndrome symptoms may recur after surgery.
- Complex Regional Pain Syndrome: This is a rare but potentially debilitating condition that can occur after surgery, characterized by chronic pain, swelling, and limited range of motion in the affected limb.
It’s important to discuss these potential risks and complications with your healthcare provider to make a well-informed decision about undergoing carpal tunnel surgery. Understanding the possible outcomes can help you weigh the benefits and risks, ensuring the best possible care for your condition.
Appointment and Treatment Plan
Appointment
Based on your previous consultation with a doctor, an appointment will be arranged between you and your surgeon.
Treatment plan
During your initial consultation you will discuss the treatment plan and agree on next steps with your surgeon.
Pre-op assessment
If surgery is an option, then the surgeon and their team will thoroughly assess whether you’re right for the surgery. They’ll consider your current health, any previous issues, and other external matters
Surgery
Prior to going through the surgery, our team will ensure that you’re prepped once again. If everything is confirmed, you’ll undergo the surgery and then we’ll explain the aftercare instructions.
Aftercare
If necessary, you’ll stay in a ward for a few hours to ensure that you’re ready to go home after the surgery. However, this may depend on the surgery outcome and whether you need moderate or light assistance.
Follow-Up
You’ll come in a few weeks later and we’ll give you one final check-over to ensure that you’re on track for recovery.
Experts
We are proud to provide patients with access to a wide range of clinicians, chosen specifically for their knowledge and reputation in their area of expertise. Our experts align with our values: putting you at the centre of your care and educating you on your options at each step of the journey. We encourage you to learn more about our clinicians and how they can help you below. As always, please contact our patient services team if you require any additional information.
We offer 3 ways to pay for your treatment
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Whether you pay in advance, spread the cost, or use your private medical insurance, rest assured you will be receiving exceptional care 365 days a year.
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Many of our treatments have a pay monthly option that allows you to spread the cost of your treatment over 12 months with no credit checks required.
A minimum spend of £300 does apply. We’ll take your first payment upfront and then arrange a direct debit for your monthly payments thereafter. It’s that simple.
Pay using PMI
We are recognised by all major health insurance companies and with our extensive range of services, there are lots of benefits to using your insurance with us. Our patient services team is here to answer any questions you may have about using your private health insurance with us.
Please bring along your policy details including your scheme details, membership or policy number, expiry date and confirmation of eligibility to claim (i.e. your authorisation number). If you do not have these details with you, we will require payment from you on the day. Patients are liable for any amounts not settled by their insurer.
Hospital fee guide price: £1,476
Procedure price subject to bespoke quotation
*Additional consultant fee not included
Medically reviewed by Mr Nawfal Al-Hadithy - Consultant Trauma & Orthopaedic Shoulder, Elbow & Hand Surgeon on 23/12/2024