Hand > Carpal Tunnel Syndrome > Treatments

   Open Surgical Release

Treatment Introduction

Open surgical release to treat carpal tunnel syndrome involves the releasing, or cutting, of a ligament in the carpal tunnel to relieve pressure on the median nerve. It is performed using an open incision, or, less commonly, with an endoscope, which is a special viewing instrument that allows a surgeon to see images of the body's internal structures through very small incisions. Be sure to have your surgeon explain the difference between these two procedures.

The decisions you make and the actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include bandages, ice packs or coolers, or heating pads. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.
Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at (919) 929-7103.

At most medical centers, you will go to "patient admissions" to check in for your surgical procedure. There may be separate check-in areas for ambulatory outpatient (patients who go home the same day after surgery) and for overnight inpatient surgery, so be sure to ask your physician or an assistant about this. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. After the paperwork is completed, you may be asked to wear a hospital gown and, if applicable, remove your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or an assistant, and meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Here are some important things to remember for the day of your surgery:

   You may be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general or local anesthesia.

   Because you may be unable to drive, arrange for someone to help take you out of the hospital and drive you home when you are released.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Open surgical release to treat carpal tunnel syndrome takes 10-20 minutes to complete. Before you undergo open surgical repair to treat carpal tunnel syndrome, you will be administered a local anesthetic to numb your wrist and hand. This may be injected either into your wrist or hand, or farther up your arm. The procedure can be performed while you are awake. Some people choose to receive sedation which is medicine that allows you to relax during the operation. Enough medicine can be given so that you can fall asleep while the doctor is working.

   Your surgeon makes an incision a little less than two inches long from the middle of your palm to your wrist.

   After locating the ligament that is pressing on your median nerve, the surgeon cuts it with a scalpel or scissors to relieve the pressure.

   Sutures are used to close the incision, and a large dressing and splint are placed on your hand and wrist to restrict motion.

This surgery is usually performed in an outpatient facility, and you are generally not required to stay overnight.

After open surgical release to treat carpal tunnel syndrome, your hand and wrist are covered in a bulky dressing and splint to restrict motion. Your fingers are free and use of the fingers is allowed for light activities. You may feel a moderate amount of pain. You usually stay in the recovery room for at least one hour while the anesthetic wears off. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days. In addition, you will be given an appointment to return in eight to 14 days to have your sutures removed. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital. The majority of patients leave the hospital after one to three hours. As soon as you are fully awakened, you usually are allowed to go home. You will probably be unable to drive a car, so be sure to have arranged a ride home.

After open surgical release to treat carpal tunnel syndrome, you may expect to keep the dressing and immobilizing splint on your hand and wrist until you have your sutures removed, usually eight to 14 days after surgery. Try to keep the sutures as dry as possible. You may find that your symptoms are relieved or significantly improved soon after your surgery, but it is important that you avoid any strenuous use of your hand for at least four weeks. Tenderness or numbness around the area of the incision may persist for several months, particularly in older patients or in more severe cases. Your physician or physical therapist may prescribe exercises to help restore strength, flexibility, and circulation to your hand and wrist. It may take several weeks before you can return to your normal level of physical activities.

If you have undergone open surgical release to treat carpal tunnel syndrome, your physician or physical therapist may recommend exercises whose goal is to increase blood flow to your hands and relieve tension in your wrists. Exercises to soften the scar and reduce its sensitivity are also performed. These exercises generally are simple to perform and can be done while you are working at your desk, watching television, or relaxing. It is particularly important to perform these exercises regularly as long as your work or leisure activities include repetitive motions that require you to flex or extend your wrist or hand.

Recurrence of carpal tunnel syndrome following a surgical release is uncommon, but can occur. One way to prevent a recurrence of carpal tunnel syndrome is to watch your posture and your movements, and to make any necessary adjustments to avoid problems. For example, if your work requires you to use a computer, check to see if your office has keyboard wrist rests that can help keep your wrist in a neutral position. Other adjustments, such as raising or lowering the height of your chair while typing, can ease strain on your wrists. Physicians also advise limiting repetitive, forceful hand movements. If you do plan on straining your hand and finger muscles, you should stretch your fingers and wrists and warm them up with some range of motion exercises. Your physical therapist can recommend these. When engaging in repetitive wrist activities, such as typing or hammering, give yourself frequent, short breaks to shake out and stretch your wrists.