Carpal tunnel decompression is the surgical treatment for carpal tunnel syndrome. The operation releases pressure on the median nerve at the wrist by dividing the flexor retinaculum, which is the ligament that forms the roof of the carpal tunnel.
Carpal tunnel decompression, also known as carpal tunnel release, is one of the most common hand operations performed. It is usually a relatively minor procedure carried out under local anaesthetic as a day case.
Mr Robert Farnell is an experienced specialist Consultant Orthopaedic Hand and Wrist Surgeon who has been working in Leeds for over 25 years. He exclusively treats conditions affecting the adult hand and wrist, including carpal tunnel syndrome, trigger finger and thumb, thumb arthritis and Dupuytren’s disease.
What is carpal tunnel decompression?
Carpal tunnel decompression is an operation to relieve pressure on the median nerve as it passes through the carpal tunnel at the wrist.
During the procedure, the flexor retinaculum is divided. This creates more space within the carpal tunnel and reduces compression of the median nerve.
The aim of surgery is to improve symptoms such as numbness, pins and needles, night-time hand pain and weakness caused by carpal tunnel syndrome.
When is surgery recommended?
Surgery may be recommended if symptoms are persistent, severe, worsening or not responding to non-surgical treatment such as splinting or steroid injection.
Surgery may also be advised when there is evidence of constant numbness, weakness or muscle wasting at the base of the thumb, as these changes may become permanent if the nerve remains compressed.
Read more about carpal tunnel syndrome.
Before your surgery
You will receive a letter with details of the date and time of your operation. This will provide information about what to do and what to expect during your treatment.
Some hospitals routinely arrange a pre-operative assessment clinic, where you will see a nurse and any relevant medical issues can be reviewed.
You will also be given advice about post-operative pain relief. Carpal tunnel decompression is not normally a very painful operation and simple painkillers such as paracetamol are often sufficient.
Because the operation is usually performed under local anaesthetic, there are normally no restrictions on eating or drinking before surgery. However, you should always follow the specific advice provided by your hospital and surgeon.
On the day of surgery
You should arrive on the ward at your allotted time. Your pre-operative letter will tell you whether you need to bring anything specific, although patients are commonly asked to bring a dressing gown and slippers.
The nursing team will complete some paperwork, check your medication and make sure you are ready for surgery.
Your surgeon will also visit you before the operation, confirm that you understand what is going to happen and answer any questions you may have.
You will be asked to sign a consent form. An arrow will also be marked on your arm using a felt-tip pen. This is routine practice and is used to identify the correct side for surgery.
Local anaesthetic
Before surgery, local anaesthetic is injected to numb the skin and tissues around the operation site.
This is usually done in the operating theatre, although some surgeons may inject the local anaesthetic on the ward before you go into theatre.
Many patients worry that the injection will be painful. Generally, if it is administered carefully, the injection is not usually painful.
What happens during the operation?
Once the local anaesthetic has worked, the operation can begin.
The skin is cleaned with antiseptic fluid and sterile towels are used to cover the area.
Some surgeons use a tourniquet to temporarily prevent blood from entering the arm. If this is used, you will be aware of a tight bandage on your upper arm, similar to the cuff used when your blood pressure is taken.
On average, the operation takes approximately ten minutes and is not usually painful. You may be aware of tugging or pulling sensations around the wrist, but this should not hurt.
If you have a personal music player, you may be able to listen to music during the operation.
After the operation
After the operation, a bandage will be applied and you will return to the ward. You will usually be offered a drink and something to eat.
Once the nurses are happy, you will be able to go home.
It is generally expected that someone accompanies you home. It is not advisable to drive yourself or to be left alone immediately after surgery.
You will usually be given a sling so that you can keep your arm elevated for a day or two. You will also be given an appointment for your next outpatient clinic review.
Looking after your hand after surgery
You should keep your hand elevated for the first few days to reduce swelling.
It is important to keep the fingers moving regularly. This helps reduce stiffness and swelling.
You will need to keep the bandage dry. The bandage usually remains in place for up to two weeks.
At your follow-up appointment, the wound will be checked. Some stitches need removing, although Mr Farnell uses dissolvable stitches which do not usually need to be removed.
It is unusual to require physiotherapy after carpal tunnel decompression.
Read more about post-operative care.
Recovery after carpal tunnel decompression
Recovery varies from patient to patient, but most people find the operation is well tolerated.
- First few days: keep the hand elevated and move the fingers regularly.
- Up to two weeks: keep the bandage clean and dry.
- After wound review: gradually increase light hand use as comfort allows.
- Several weeks to months: scar tenderness and grip weakness gradually improve.
Night-time symptoms and sensory symptoms often improve immediately or shortly after surgery.
However, sensation may not return fully to normal, especially if the hand was constantly numb before the operation.
Possible complications
Complications after carpal tunnel decompression are uncommon and are usually minor.
- Scar tenderness: this is the most commonly experienced problem. It is a nuisance but usually resolves completely. Massaging the scar with moisturiser can help it settle.
- Wound infection: this is seen in up to 1% of cases.
- Finger stiffness: this is uncommon and is best avoided by keeping the fingers moving.
- Median nerve injury: this has been described but is very rare.
Prognosis after surgery
Night-time and sensory symptoms usually resolve immediately or shortly after surgery.
If the hand was constantly numb before surgery, sensation may not return completely to normal. Muscle wasting, if present, may also be permanent.
The surgical scar usually heals well. Once the redness and lumpiness have settled, it often fades and looks like a natural skin crease.
Considering carpal tunnel surgery?
If carpal tunnel symptoms are affecting your sleep, hand function or grip strength, Mr Robert Farnell can assess your symptoms and advise whether carpal tunnel decompression may be appropriate.
Carpal tunnel decompression FAQs
What is carpal tunnel decompression?
Carpal tunnel decompression is an operation to release pressure on the median nerve at the wrist by dividing the flexor retinaculum.
Is carpal tunnel decompression the same as carpal tunnel release?
Yes. Carpal tunnel decompression and carpal tunnel release are different names for the same operation.
Is carpal tunnel surgery painful?
The operation is not usually painful. It is normally performed under local anaesthetic and patients may feel tugging or pulling but should not feel pain.
How long does carpal tunnel surgery take?
The operation takes approximately ten minutes on average.
Do I need to be asleep for carpal tunnel surgery?
No. Carpal tunnel decompression is usually performed under local anaesthetic as a day case procedure.
Can I eat and drink before carpal tunnel surgery?
Because the operation is usually performed under local anaesthetic, there are normally no restrictions on eating or drinking. You should follow the instructions provided by your hospital and surgeon.
How long does the bandage stay on?
The bandage usually remains in place for up to two weeks and should be kept dry.
Will I need physiotherapy?
It is unusual to require physiotherapy after carpal tunnel decompression.
How soon do symptoms improve?
Night-time symptoms and sensory symptoms often improve immediately or shortly after surgery.
Can numbness remain after surgery?
Yes. If the hand was constantly numb before surgery, sensation may not return fully to normal.
What are the risks of carpal tunnel decompression?
Risks include scar tenderness, wound infection, finger stiffness and very rarely median nerve injury.