A small surgical procedure in which the ligament is divided to relieve numbness, tingling and weakness caused by pressure on the median nerve as it passes through the narrow tunnel at the wrist.
Indication
- Moderate to severe carpal tunnel syndrome confirmed by EMG (electromyography)
- Nighttime numbness, tingling and disrupted sleep (the classic complaint)
- Loss of sensation or reduced dexterity in the thumb, index and middle fingers
- Cases unresponsive to conservative treatment (night splint, NSAIDs, local corticosteroid injection)
- Advanced cases with thenar (thumb muscle) atrophy
- Symptoms that limit daily life and occupational activities
Preparation
- Nerve conduction study with EMG and a detailed clinical examination
- Evaluation of accompanying conditions (diabetes, thyroid disease, rheumatoid arthritis)
- If blood thinners are used, they are discontinued with physician approval
- Pre-procedure skin cleansing and removal of accessories
- No fasting requirement when local anesthesia is used
How it's performed
- Local anesthesia is generally administered (with light sedation if needed)
- An incision of about 2-3 cm (open surgery) or 1 cm (endoscopic) is made on the palm at wrist level
- The transverse carpal ligament compressing the median nerve is carefully divided to widen the tunnel
- Nerve integrity and free movement are checked
- The skin is closed with a few sutures and an elastic bandage is applied
- The procedure takes an average of 15-30 minutes
Post-procedure
- The procedure is outpatient (day surgery); discharge the same day
- For the first 2-3 days, the hand is kept elevated; tight gripping and heavy lifting are avoided
- The dressing is removed after 7-10 days, and sutures are taken out at 10-14 days
- Nighttime numbness usually improves quickly within the first weeks; full recovery takes 2-3 months
- Return to light work and daily activities within 1-2 weeks; heavy hand work in 4-6 weeks
Risks
- Infection (rare)
- Wound pain or transient tenderness (pillar pain), usually resolving within weeks
- Injury to the median nerve or its branches (very rare)
- Insufficient decompression or recurrent compression (late period)
- Transient numbness related to the anesthetic area
FAQ
Is carpal tunnel surgery essential, or can it be managed with a splint?
In mild cases, symptoms can be controlled with a night splint, corticosteroid injection and activity modification. If EMG shows moderate to severe compression, muscle wasting, or there is no response to conservative treatment, surgery is recommended; delay may lead to permanent nerve damage.
When will my symptoms resolve after surgery?
Nighttime numbness usually improves rapidly within the first few weeks. Full return of finger sensation and grip strength may take 2-6 months depending on the condition of the nerve. In advanced cases, complete recovery may not occur.
When can I return to work?
Desk work can be resumed within 1-2 weeks; jobs requiring heavy hand use (construction, assembly) after 4-6 weeks. The timeline varies with the type of procedure and the occupation.
Is open or endoscopic surgery preferred?
Both methods are effective. Endoscopic surgery uses a smaller incision and offers earlier return to work. Open surgery provides wider visualization. The choice depends on the surgeon's experience and the patient's characteristics.
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