Carpal Tunnel Syndrome

• Numbness or tingling in the thumb, index, middle and half of the ring finger
• Symptoms that are worse at night and may wake you from sleep
• A feeling that the hand has "gone to sleep"
• Dropping objects or difficulty with fine tasks
• Aching or discomfort in the hand or wrist
• Weakness of the thumb, particularly in more advanced cases

I often explain the carpal tunnel using the analogy of a small lift with ten people squeezed inside.

The lift is the carpal tunnel. The people are the tendons and median nerve that have to pass through it.

The problem is that either the lift is too small, the people are taking up too much space, or a combination of the two. Eventually there simply isn't enough room, and the median nerve becomes compressed.

As a hand surgeon, my job is to open the lift doors and give the nerve more breathing room.

Endoscopic release uses a small camera through 2 small (<1 cm) incisions to divide the ligament forming the roof of the carpal tunnel.

The aim is exactly the same as open surgery — to release the pressure on the median nerve — but with less disruption to the tissues of the palm.

For many patients this means:

• A smaller incision
• Less palm tenderness
• Less discomfort with gripping and putting weight through the hand
• Earlier return to comfortable everyday activities
• A less noticeable scar

Endoscopic release is not suitable for every patient, and I will discuss the most appropriate technique for you.

Learn more about endoscopic carpal tunnel release  

The traditional technique uses a 2–3 cm incision in the palm to divide the same ligament.

It is a well-established and highly effective procedure. The main difference is that the incision sits directly in the palm, which can make gripping and putting pressure through the hand more uncomfortable during the early recovery.

Both techniques are very successful at relieving pressure on the median nerve.

Carpal tunnel release is one of the most successful operations in hand surgery, and I have a relatively low threshold for discussing surgery when symptoms are persistent, troublesome, affecting sleep or function, or there is evidence of significant nerve compression.

Carpal tunnel release is usually day surgery.

• First week: Night-time disturbance and pain from the nerve compression usually settle within the first week. Most patients need only Panadol, if anything, for postoperative discomfort.
• Week 1: I review you to debulk the dressings and check the wound.
• Week 2: Sutures are removed and dressings can usually come off completely.
• Desk work: Usually possible early, depending on comfort and the demands of your job.
• Manual work: Generally around 2 weeks after endoscopic release and 4 weeks after open release, depending on the job.
• Sport and gym: You can return when you are comfortable and have sufficient strength and movement. However, the palm can remain sensitive for several months.
• Pillar pain: Some patients experience tenderness on either side of the carpal tunnel incision when loading the palm. This can last for around 3 months, making activities such as a push-up position uncomfortable.

The symptoms caused by nerve compression and the recovery of the nerve itself are two different things.

The night-time symptoms and pain often improve within the first week, but sensory and muscle recovery takes much longer.

• Sensory recovery: Allow at least 4 months for numbness and altered sensation to improve.
• Muscle recovery: If there has been weakness or wasting of the thumb muscles, recovery takes at least 6 months and can take considerably longer.
• Severe carpal tunnel: Around 20% of patients with severe carpal tunnel syndrome are still recovering at one year. Nerves regenerate very slowly, so ongoing numbness does not necessarily mean that the surgery has not worked.