Peripheral nerve surgery in which the transverse carpal ligament forming the roof of the carpal tunnel is divided to relieve pressure on the median nerve.
Indication
- Carpal tunnel syndrome unresponsive to conservative treatment (splinting, physical therapy, local corticosteroid injection)
- Hand and finger numbness, tingling and pain that worsen at night
- Moderate to advanced cases with thumb weakness and thenar muscle atrophy
- Patients with moderate or severe median nerve entrapment confirmed by EMG (nerve conduction study)
- Carpal tunnel syndrome resistant to treatment due to secondary causes such as diabetes, hypothyroidism or pregnancy
- Need for revision surgery in recurrent carpal tunnel syndrome
Preparation
- EMG and necessary imaging (ultrasound or MRI) results are brought along
- Fasting is not required for local anesthesia; for sedation or general anesthesia, fasting from food and drink for 6-8 hours is required
- Blood thinners are adjusted with physician approval
- It is confirmed that there is no infection or open wound on the wrist
- Having a companion is recommended as patients should not drive after surgery
How it's performed
- The patient is placed supine with the arm on a hand table and the skin is sterilized
- Generally performed under local anesthesia (a small area of the palm is numbed)
- A small 2-3 cm incision is made at the wrist-palm junction (classical open technique); some centers may prefer the endoscopic technique
- The transverse carpal ligament is carefully divided to release pressure on the median nerve
- The nerve is checked visually for adequate decompression and any additional points of compression
- The skin is closed with a few sutures and a light dressing is applied; same-day discharge is common
Post-procedure
- The dressing is kept on for 24-48 hours, and the wound is then kept clean and dry
- Numbness usually begins to subside within the first weeks; full recovery may take 2-3 months
- Sutures are removed in 10-14 days
- Light hand movements can begin early; heavy lifting and repetitive strain should be avoided for 4-6 weeks
- Patients are informed that tenderness in the soft tissue of the palm (pillar pain) may last for several months
Risks
- Wound infection (rare)
- Temporary or permanent sensory change in a small branch of the median nerve
- Long-lasting tenderness in the palm (pillar pain)
- Incomplete or delayed recovery in patients who present late at advanced stages
- Recurrence (especially if the ligament is not fully released or the underlying cause persists)
FAQ
Can I use my hand right after the procedure?
Light daily activities (eating, dressing) are possible from the early days. Heavy lifting, gripping and repetitive strain are not recommended for 4-6 weeks.
When will my complaints resolve?
Night-time numbness usually decreases noticeably within the first week. Full recovery of sensation and strength may take 2-6 months depending on the degree of nerve damage.
Is there a difference between the open and endoscopic techniques?
Long-term outcomes are similar between the two techniques. The endoscopic approach may allow a smaller incision; the open approach offers easier visualization in revision and complex cases. The choice depends on the surgeon's experience and the patient's clinical condition.
I have the same problem in my other hand. Can both hands be operated on in the same session?
Generally, the more symptomatic hand is operated on first; the second hand is scheduled later to allow assessment of recovery. However, both hands may be operated on in the same session in selected patients.
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