Open Carpal Tunnel Surgery for Carpal Tunnel Syndrome

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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.

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 1 to 2 weeks 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.

The timing of your return to work depends on the type of surgery you had, whether the surgery was on your dominant hand (the hand you use most), and your work activities.

If you had open surgery on your dominant hand and you do repeated actions at work, you may be able to return to work in 6 to 8 weeks. Repeated motions include typing or assembly-line work. If the surgery was on the other hand and you do not do repeated actions at work, you may be able to return to work in 7 to 14 days.

If you had endoscopic surgery, you may be able to return to work sooner than with open surgery.

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.footnote 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.

Both endoscopic and open carpal tunnel release have benefits and risks. Studies do not show that one procedure is better than the other.footnote 2

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%).footnote 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 may require 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.footnote 1

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. Ashworth NL (2014). Carpal tunnel. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1114/overview.html. Accessed October 2, 2014.
  2. Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).

Credits

ByHealthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Herbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery

Current as ofMay 23, 2016