Carpal Tunnel Release

Carpal tunnel release is a surgical procedure to treat carpal tunnel syndrome. Carpal tunnel syndrome is a common disorder caused by compression of the median nerve in the wrist. Carpal tunnel syndrome can lead to pain, numbness, and sometimes disability of the hands. In carpal tunnel release, your doctor relieves pressure on the median nerve by cutting part of the carpal ligament, a band of tissue that holds the wrist joint together.

Carpal tunnel release is a very common surgery, but it carries risks and potential complications. Your doctor will probably recommend less invasive treatment options for carpal tunnel syndrome before considering carpal tunnel release for you. You should discuss different treatment options with your doctor to best understand which option is best for you. 

Why is carpal tunnel release performed?

Carpal tunnel release is a surgical treatment for carpal tunnel syndrome. Carpal tunnel syndrome is often associated with repetitive actions of the hands and wrists. This commonly occurs from long-term keyboarding, use of vibrating tools, or assembly line jobs. With time, these actions can cause swelling and increased pressure on the median nerve. This can lead to pain and numbness that can become disabling. Other conditions that can cause carpal tunnel syndrome include diabetes, pregnancy, menopause, a hand or wrist injury, and rheumatoid arthritis.

Your doctor will not likely consider carpal tunnel release for you unless less invasive treatments have been ineffective. These include:

• Acupressure and acupuncture, which may help reduce pressure on the median nerve
• Anti-inflammatory medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and aspirin. NSAIDs are very effective in treating carpal tunnel syndrome. However, long-term use of NSAIDs can cause serious, even life-threatening, side effects. These include bleeding stomach ulcers and heart problems. You should only take NSAIDs as directed by your healthcare provider.
• Changing or limiting repetitive motion or jarring activities of the hands and wrists. These include typing, keyboarding,sewing, performing dental work, and using a chainsaw or jack hammer.
• Corticosteroids to reduce the inflammation and pain of carpal tunnel syndrome. You generally receive corticosteroids through direct injection into the carpal tunnel of the wrist.
• Ensuring that keyboards are placed low enough so that wrists are not flexed while working
• Not flexing the wrists for long periods of time. For example, your doctor may recommend that you wear a wrist brace at night to prevent your wrists from flexing while you are sleeping.
• Seeking regular medical care and following your treatment plan for underlying conditions, such as acromegaly, diabetes, hypothyroidism, pregnancy, rheumatoid arthritis, and hand and wrist trauma and fractures

How is carpal tunnel release performed? 

An orthopedic surgeon will lead a team to perform your carpal tunnel release in a hospital or outpatient setting. An orthopedic surgeon is a doctor who specializes in diseases and conditions of the bones, muscles and joints.

The median nerve runs through the wrist in a narrow channel called the carpal tunnel. The carpal tunnel is created by wrist bones and the carpal ligament, which is a band of tissue that holds the wrist joint together. In carpal tunnel release, your orthopedic surgeon makes an incision in the wrist. He or she then cuts into the carpal ligament. This enlarges the space in the carpal tunnel and relieves pressure on the median nerve. 

The procedure takes about an hour, depending on the specific surgical approach. It is an outpatient procedure and you go home the same day.

Surgical approaches to a carpal tunnel release

Your doctor will perform your carpal tunnel release using one of the following approaches:

• Minimally invasive surgery, or endoscopic carpal tunnel release, is performed by inserting special instruments and an endoscope through one or two small ½ inch incisions in the wrist. The endoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your doctor sees the surgical area on the video screen as he or she performs the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues. Your surgeon will make a small incision instead of a larger one used in open surgery. He or she can then thread surgical tools around muscle and other structures instead of cutting through or displacing them as in open surgery.
• Open surgery is performed by making a two inch incision in your wrist. Open surgery allows your surgeon to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. This is because it causes more trauma to tissues. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.