What are the different types of surgery?

There are two possible surgical procedures:

• Open carpal tunnel release: A cut is made on the wrist to sever the transverse carpal ligament.
• Endoscopic carpal tunnel release: Here the surgeon makes two small cuts: one on your palm and one on your wrist. A tube with a small camera at the end (endoscope) is inserted through one of the cuts in order to monitor the procedure. An instrument is inserted through the second cut to then cut right through the transverse carpal ligament. Another endoscopic technique involves using just one small cut in the wrist.

Open surgery and endoscopic surgery are equally good at relieving symptoms and associated with similar risks. Recovery times may be a little shorter after endoscopic procedures, allowing people to return to work sooner.

This procedure is usually done as day surgery, but it can also be done in a hospital. Usually a local anesthetic is enough to numb the hand or arm. A brief general anesthetic is sometimes used, though.

How effective is surgery?

Surgery is usually only considered if symptoms return regularly despite trying out other treatments such as splints and steroid injections, and if problems due to the painful abnormal sensations get worse. In those cases, surgery can provide better relief than repeat injections or splint treatments can.

Most people’s symptoms go away after surgery: If the nerve is not yet severely damaged and you don't experience persisting loss of strength or abnormal sensations, then the symptoms usually improve within a few weeks. So it might be a good idea to not wait too long to have surgery.

It can take several weeks or months for more severe symptoms to go away completely, particularly if the symptoms were severe. The pain usually improves pretty fast, but the abnormal sensations may need more time to disappear. Even several years after surgery, about 75 to 90 out of 100 people still have no symptoms or at least fewer symptoms than before.

What can you do if the surgery doesn't help enough?

Sometimes surgery doesn't provide as much relief as expected. The symptoms may not go away, or they might come back afterwards. It's difficult to predict how effective surgery will be. This may depend on things like how long you have had symptoms and how severe they are, or whether you have other illnesses.

If the surgical procedure doesn't have the desired outcome, there are a number of possible explanations:

• The condition might already be at such an advanced stage that the damage to the nerve is permanent. Then surgery can no longer make the symptoms go away completely.
• The diagnosis was not correct. That means that the surgery was performed although something else was causing the symptoms.
• If a mistake was made during surgery or the transverse carpal ligament wasn't cut through completely. The symptoms may then persist or get worse.

If you still have severe symptoms even after surgery, it's a good idea to be examined by a doctor again. More surgery may then be considered.

What risks are associated with the surgery?

You may experience bruising in your hand or temporary numbness after the procedure. That usually disappears after a few weeks. But longer-lasting problems may arise as well, such as pain.

Pain along the surgical scar is more common in open carpal tunnel release surgery, while nerve damage is more common in endoscopic carpal tunnel release surgery. About 5 out of 100 people who have open carpal tunnel release surgery develop these kinds of minor complications, compared to about 3 out of 100 people who have endoscopic surgery.

Fewer than 1 out of 100 people have more major complications following surgery. Examples of such complications include a swollen hand or median nerve damage. In these cases trouble moving the hand, pain and numbness might not go away.

The risk of complications also depends on how experienced the surgeons are. This is especially true for the endoscopic procedures, which are slightly more difficult to do.

Things to remember after the surgery

Your wrist is wrapped in a bandage for a few days after surgery. The stitches are removed after about two weeks. There are differing opinions on how long you need to rest your hand after having surgery. Some doctors recommend keeping it in a splint for a few days to prevent it from moving, but there is no scientific evidence that this helps. So there is usually nothing wrong with moving your hand the day after surgery and putting a little strain on it. Starting to move your hand earlier can even have advantages:

Heavy lifting and major strain should be avoided for several weeks to give the wound a chance to heal properly. The type of work you do will determine how early you can return to work. If you don't have to put much strain on your wrist at your job, about three weeks is usually enough. People who do more manual work may need to wait four to six weeks.

Sources

• Deutsche Gesellschaft für Handchirurgie (DGH), Deutsche Gesellschaft für Neurochirurgie (DGNC). Diagnostik und Therapie des Karpaltunnelsyndroms (S3-Leitlinie). AWMF-Registernr.: 005-003. 2022.
• Huisstede BM, van den Brink J, Randsdorp MS et al. Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome-A Systematic Review. Arch Phys Med Rehabil 2018; 99(8): 1660-1680. [PubMed: 28577858]
• Li Y, Luo W, Wu G et al. Open versus endoscopic carpal tunnel release: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2020; 21(1): 272. [PMC free article: PMC7187537] [PubMed: 32340621]
• Louie D, Earp B, Blazar P. Long-term outcomes of carpal tunnel release: a critical review of the literature. Hand (N Y) 2012; 7(3): 242-246. [PMC free article: PMC3418353] [PubMed: 23997725]
• Lusa V, Karjalainen TV, Pääkkönen M et al. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev 2024; (1): CD001552. [PMC free article: PMC10772978] [PubMed: 38189479]
• Peters S, Page MJ, Coppieters MW et al. Rehabilitation following carpal tunnel release. Cochrane Database Syst Rev 2016; (2): CD004158. [PMC free article: PMC10493644] [PubMed: 26884379]
• Shi Q, MacDermid JC. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res 2011; 6: 17. [PMC free article: PMC3080334] [PubMed: 21477381]
• Vasiliadis HS, Georgoulas P, Shrier I et al. Endoscopic release for carpal tunnel syndrome. Cochrane Database Syst Rev 2014; (1): CD008265. [PMC free article: PMC10749585] [PubMed: 24482073]

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