Carpal Tunnel Syndrome (CTS) can have a serious impact on your daily life, causing pain, numbness, and weakness in your hand. These symptoms can make even simple tasks, like gripping objects or typing, feel uncomfortable or unsustainable. If you’ve tried non-surgical treatments like wrist splints or medication without success, you may be considering surgery as your next step toward relief. But where exactly is carpal tunnel surgery performed, and what does the procedure involve?
At The Nerve Surgery Centre, we specialise in treating conditions like Carpal Tunnel Syndrome, providing expert care to help you regain comfort and function in your hands. We know how important it is to find effective solutions for nerve-related issues that can affect your quality of life. Whether you’re looking for carpal tunnel surgery in Birmingham, Worcester, or surrounding areas, we offer a range of treatment options, tailored to meet your individual needs.
In this article, we’ll walk you through the details, including which parts of the hand and wrist are involved, what to expect during surgery, and answers to common questions about the recovery process. (For those who’ve already had carpal tunnel surgery or who are planning ahead, be sure to have a look at our guide on when to start physical therapy after carpal tunnel surgery.)
Understanding Carpal Tunnel Syndrome (CTS)
What Is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) happens when the median nerve, which runs from your forearm into your hand, gets compressed or squeezed as it passes through the narrow carpal tunnel in your wrist. This tunnel is made up of bones and ligaments, and when pressure builds up, it affects the nerve’s function.
If you have CTS, you might feel tingling, numbness, or pain in your hand, particularly in your thumb, index, and middle fingers. For many, these symptoms worsen at night or when holding something for an extended time.
What Causes Carpal Tunnel Syndrome?
There are many potential causes of CTS. Repetitive hand movements, such as typing or using tools, can lead to strain on the wrist. Conditions like arthritis or diabetes may also contribute, as they can cause swelling or other changes in the body that increase pressure on the median nerve.
While lifestyle adjustments or non-surgical treatments like wrist splints or steroid injections may help, carpal tunnel surgery is sometimes the best long-term solution when symptoms are severe or persistent.
Why Do Surgeons Perform Carpal Tunnel Surgery?
Carpal tunnel surgery is performed when other treatments, such as splints, medication, or physical therapy, haven’t provided enough relief. The primary goal of surgery is to relieve pressure on the median nerve by cutting a ligament in your wrist, allowing the nerve to pass through freely.
Once pressure is reduced, your symptoms should begin to improve, and in most cases, full hand function can be restored over time.
Where Is Carpal Tunnel Surgery Performed?
Carpal tunnel surgery primarily targets the wrist, but its benefits extend throughout the hand, particularly in the areas affected by pressure on the median nerve. Let’s have a closer look at what this surgery involves and the parts of the body that are affected.
The Carpal Tunnel and Its Role in Your Wrist
The carpal tunnel is a narrow passageway located in your wrist. It’s made up of bones and ligaments and serves as a pathway for tendons and the median nerve, which controls sensations and movement in your thumb and fingers. When this tunnel becomes compressed, it puts pressure on the median nerve, leading to the symptoms of Carpal Tunnel Syndrome.
What Is the Transverse Carpal Ligament?
A key component of carpal tunnel surgery is the transverse carpal ligament, which forms the roof of the carpal tunnel. This strong band of tissue plays a vital role in holding the tendons of your wrist in place as they move. However, when pressure builds up in the carpal tunnel, this ligament contributes to the compression of the median nerve. During surgery, the primary focus is on releasing this pressure by cutting through the transverse carpal ligament.
How Does Cutting the Ligament Help Relieve Symptoms?
By cutting the transverse carpal ligament, the surgeon creates more space within the tunnel, allowing the median nerve to pass through freely without being compressed. This technique is known as a carpal tunnel release. Once the ligament is severed, the pressure on the nerve is reduced, and the symptoms of numbness, tingling, and pain begin to diminish. Over time, the ligament heals in a way that provides more room in the tunnel, ensuring that the nerve can function properly without becoming compressed again.
What Other Tissues Are Involved in the Surgery?
While the bones in the wrist aren’t directly operated on during carpal tunnel surgery, the procedure does involve other important tissues. These include the tendons that pass through the carpal tunnel alongside the median nerve. Though the surgery doesn’t alter these tendons, the surgeon takes great care to navigate around them to avoid causing any damage. Additionally, the soft tissues and skin surrounding the wrist are affected, as they will be part of the incision area and the healing process.
Does Carpal Tunnel Surgery Affect the Whole Hand?
While the surgery is performed on the wrist, the effects can be felt throughout the hand. This is because the median nerve is responsible for sensation and movement in much of your hand, including the thumb, index finger, middle finger, and part of the ring finger. After the pressure is relieved through surgery, patients often report an improvement in function and comfort not just in the wrist but also in these parts of the hand. However, the pinky finger is in most cases not affected by the median nerve and is unlikely to see any direct impact from the surgery.
What Are the Two Types of Carpal Tunnel Surgery?
There are two main types of carpal tunnel surgery: open release surgery and endoscopic surgery.
- Open Carpal Tunnel Release Surgery – This is the more traditional method, where the surgeon makes a small cut in the palm near the wrist. Through this incision, they can directly view the ligament and cut it to relieve pressure on the nerve. Recovery can take a little longer, but it’s a straightforward and effective method.
- Endoscopic Carpal Tunnel Release Surgery – In this minimally invasive approach, the surgeon makes one or two smaller incisions and uses a camera (endoscope) to guide the cutting of the ligament. Recovery tends to be quicker with less scarring, but not everyone is a suitable candidate for this method.
Both types of surgery have high success rates, and your doctor will help determine which option is best for you based on your condition and medical history.
What Should You Expect During and After Surgery?
How Long Does the Surgery Take and Where Is It Done?
Carpal tunnel surgery is typically quick, often taking less than an hour to perform. It’s usually done as an outpatient procedure, meaning you can go home the same day.
Many surgeries are performed in hospitals, outpatient surgical centres, or specialised clinics that focus on nerve-related conditions. You’ll be under local anaesthesia, so while you’ll be awake, you won’t feel any pain in the area being operated on.
What Is the Recovery Process Like?
Recovery from carpal tunnel surgery can vary from person to person, but there are some common stages you can expect.
Immediately after surgery, you’ll likely have some swelling and discomfort in your wrist and hand. Your surgeon may place a bandage or splint on the wrist to keep it stabilised and reduce movement.
Over the next few weeks, you’ll gradually regain strength and mobility, though you might need to avoid certain activities for a while. These include:
- Heavy Lifting – Avoid lifting anything heavy, as this can put undue pressure on your wrist and interfere with the healing process.
- Repetitive Hand Movements – Actions like typing, using tools, or gripping objects for long periods should be minimised to reduce strain on the tendons and median nerve.
- Driving – Depending on your recovery, you may need to avoid driving until you regain full strength and control in your hand to safely operate a vehicle.
Your surgeon will provide specific guidance based on your progress to help you return to normal activities at the right pace.
How Long Before You Can Use Your Hand Normally Again?
Most people can start using their hand for light activities within a few days to a week, but full recovery can take several weeks to months, depending on the type of surgery and the severity of your condition before the procedure.
In the case of endoscopic surgery, the recovery time is typically faster, while open surgery may take longer to heal. Your doctor may recommend hand therapy or specific exercises to help strengthen your hand and restore full function.
Common Questions About Carpal Tunnel Surgery
Do You Need General or Local Anaesthesia?
Most carpal tunnel surgeries are done under local anaesthesia with sedation. This means you’ll be awake during the procedure, but your wrist and hand will be numbed so you won’t feel any pain. Some patients may have a mild sedative to help them relax, but general anaesthesia (where you’re completely unconscious) is rarely needed.
Will You Have a Scar After Surgery?
The size and visibility of the scar depend on the type of surgery. With open surgery, you’ll have a small scar on your palm near the wrist, but it tends to fade over time. In endoscopic surgery, the scars are usually smaller and less noticeable. Either way, your doctor will give you instructions on how to care for the incision to ensure it heals properly.
Can Carpal Tunnel Come Back After Surgery?
While carpal tunnel surgery is effective for most people, there is a small chance that symptoms can return. Recurrence is rare but possible, particularly if the underlying causes of the condition, such as repetitive strain or health conditions, are not addressed. Your surgeon will discuss ways to prevent a recurrence, such as making ergonomic adjustments to your daily activities.
How to Prepare for Carpal Tunnel Surgery
What Should You Do Before the Surgery?
Preparing for surgery involves a few simple steps. Your surgeon will likely ask you to stop taking certain medications, such as blood thinners, a few days before the procedure. It’s also a good idea to arrange for someone to drive you home after surgery, as your hand and wrist will be bandaged, and you may feel drowsy from any sedation.
What Questions Should You Ask Your Surgeon?
It’s important to feel comfortable and informed before your surgery. Some good questions to ask include:
- What’s the expected recovery time for me?
- Are there any specific risks in my case?
- Will I need physical therapy after the procedure?
- How can I prevent carpal tunnel from recurring?
Having these answers will help you feel more prepared and confident going into surgery.
Taking the Next Step Towards Relief
Carpal tunnel surgery can significantly improve your quality of life, especially if you’ve been struggling with persistent pain, numbness, or weakness in your hand. By relieving pressure on the median nerve, the surgery helps restore function and reduces discomfort. Carpal tunnel surgery isn’t just about fixing a physical problem—it’s about giving you the ability to return to the activities you love, pain-free.
If you’re considering surgery, consulting with an experienced specialist at The Nerve Surgery Centre can help you decide if it’s the right choice for you. Book an appointment today to discuss your options.
Medically Reviewed by Mr Tomas Madura:
Mr Tomas Madura MD(Hons), PhD, FRCS(Plast), is a highly experienced Consultant Plastic Surgeon specialising in hand and peripheral nerve surgery, with over two decades in the medical field. He has been a Consultant at the Birmingham Hand Centre and Brachial Plexus and Peripheral Nerve Injury Service at the Queen Elizabeth Hospital in Birmingham since 2017. Mr Madura’s distinguished career includes a PhD in Neurobiology from Osaka University, multiple fellowships in reconstructive microsurgery and peripheral nerve surgery, and numerous contributions to research in the field of nerve injuries and paralysis.
He is a Fellow of the Royal College of Surgeons of Edinburgh and a full member of several prestigious organisations, including the British Association of Plastic Reconstructive and Aesthetic Surgeons and the British Society for Surgery of the Hand. Mr Madura has been recognised with the Syme Medal for outstanding contributions to surgical research.
For more information, please visit his About page.
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