Carpal tunnel syndrome is a common cause of radiating pain, weakness, and numbness in the hand. Doctors can usually treat mild cases of carpal tunnel syndrome with nonsurgical remedies, such as splinting the wrist and prescribing anti-inflammatory drugs. When such remedies are ineffective or pain is severe, an outpatient surgical procedure called carpal tunnel release can be performed. Carpal tunnel release involves severing the tight tendon that is putting excess pressure on the median nerve and causing symptoms. The surgery has a high rate of success and most patients experience nearly full recoveries in about one month.
There are two main options for carpal tunnel release: endoscopic and open hand surgery. A surgeon decides which procedure to perform based on the severity of nerve damage and the length of time a patient has experienced symptoms. Open carpal tunnel release is generally preferred when the condition comes on quickly and causes serious pain or numbness. Endoscopic procedures are usually reserved for chronic conditions that, while not debilitating, cause lasting pain and discomfort. Both procedures can be performed on an outpatient basis at a surgical center under general or localized anesthesia.
During an open carpal tunnel release, a one- to two-inch (about 2.5- to 5- centimeter) incision is made from the base of the palm toward the base of the ring finger. The surgeon pulls aside fat and muscle tissue to expose the carpal tunnel ligament and the underlying median nerve. A specialized scissor instrument is used to open the ligament, thereby immediately relieving tension on the nerve. The surgeon inspects the nerve to make sure it has not been permanently damaged, replaces fat tissue, and sutures the incision wound.
An endoscopic carpal tunnel release involves making two or more smaller incisions in the hand. A tiny camera called an endoscope is inserted through one of the cuts, allowing the surgeon to inspect the nerve via a video feed. Precision cutting instruments are manipulated through another incision to snip the tendon, and the cuts are sutured with stitches. Endoscopic procedures are usually preferred over open hand surgery when the surgeon is sure that extensive median nerve damage is absent.
Following either type of procedure, topical antibiotics are applied and the hand is bandaged. Some surgeons choose to fit patients with soft splints to provide protection and immobilize the hand during recovery. People are usually instructed to rest their hands for several days and return for follow-up visits after about one week to monitor progress. Light stretching and strengthening exercises are important in the weeks after surgery to regain mobility in the hand and promote a complete recovery.
