Surgery Overview
During open carpal tunnel release surgery,
the
transverse carpal ligament is cut, which releases
pressure on the
median nerve and relieves the symptoms of carpal
tunnel syndrome.
An incision is made at the base of the palm of
the hand. This allows the doctor to see the transverse carpal ligament. After
the ligament is cut, the skin is closed with stitches. The gap where the
ligament was cut is left alone and eventually fills up with scar tissue.
See a picture of
open carpal tunnel release surgery.
If you have open carpal
tunnel release surgery, you typically do not need to stay in the hospital. It is
usually done under
local anesthetic, and you can go home on the same
day.
What To Expect After Surgery
After surgery, the hand is wrapped.
The stitches are removed 10 to 14 days after surgery. The pain and numbness may go away right after
surgery or may take several months to subside. Try to avoid heavy use of your
hand for up to 3 months.
When you return to work depends on
whether the dominant hand (the hand you use most) was involved, what your work
activities are, and how much effort you put into rehabilitative physical
therapy.
- If you have surgery on your nondominant hand
and do not do repetitive, high-risk activities at work, you may return to work
within 1 to 2 days, although 7 to 14 days is most common.
- If you
have surgery on your dominant hand and do repetitive activities at work, you
may require 6 to 12 weeks for a full recovery before you can return to previous
work duties. Physical therapy may speed your recovery.
Why It Is Done
Open carpal tunnel surgery is
considered when:
- Symptoms are still present after a long period
of nonsurgical treatment. In general, surgery is not considered until after several weeks to months of nonsurgical treatment. But this assumes that you are having
ongoing symptoms but no sign of nerve damage. Nerve damage would make surgery
more urgent.
- Severe symptoms (such as persistent loss of feeling or
coordination in the fingers or hand, or no strength in the thumb) restrict
normal daily activities.
- There is damage to the median nerve (shown
by nerve test results and loss of hand or finger function), or a risk of nerve
damage.
- Tumors or other growths need to be removed.
How Well It Works
Most people who have surgery for
carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their
hand after surgery.1
In rare cases, the symptoms of
pain and numbness may return (the most common complication), or there may be
temporary loss of strength when pinching or gripping an object, due to the
cutting of the transverse carpal ligament.
If the thumb muscles
have been severely weakened or wasted away, hand strength and function may be
limited even after surgery.
Risks
The risk and complication rates of open surgery
are very low. Major problems such as nerve damage happen in fewer than 1 out of
100 surgeries (less than 1%).2 There is a small risk
that the median nerve or other tissues may be damaged during surgery. After
open surgery, recovery may be slower than after endoscopic surgery. And there
may be some pain in the wrist and hand. You may also have some tenderness
around the scar. There are also the risks of any type of surgery, including
possible infection and
risks of general anesthesia. But most open carpal
tunnel surgery is done with
local anesthesia or regional block rather than with
general anesthesia.
What To Think About
Open carpal tunnel surgery cuts
open the base of the palm and requires a longer recovery period than endoscopic
surgery. Temporary nerve problems may be less likely with open surgery. But painful scar tissue may be more likely to develop after open surgery
than after endoscopic surgery.1
Both
endoscopic and open carpal tunnel release have benefits and risks. Studies do
not show that one procedure is better than the other.2
Talk to your doctor about your options.
Carpal Tunnel Syndrome: Should I Have Surgery?
Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.
References
Citations
- Ashworth N (2011). Carpal tunnel syndrome, search date
July 2011. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com
- Scholten RJPM, et al. (2007). Surgical treatment
options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Herbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery |
|---|
| Last Revised | October 2, 2012 |
|---|
Ashworth N (2011). Carpal tunnel syndrome, search date
July 2011. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com
Scholten RJPM, et al. (2007). Surgical treatment
options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).
