Carpal tunnel decompression - open and keyhole surgery

Procedure

The procedure to release the median nerve in the carpal tunnel is typically performed awake with a local anaesthetic injection in the hand. It can be performed as an open operation or as a keyhole (endoscopic) one. A tourniquet is placed around the upper arm and is typically inflated for less that 10 minutes. For the open procedure an incision about 4cm long is made in the palm and for the keyhole procedure a 1cm cut is made in the wrist. A ligament the is causing the pressure on the nerve is divided to release the trapped nerve and the wound is closed with stitches.

Aftercare

After your operation the most important things to do are to keep the fingers moving and keep the wounds clean and dry. It is typically not a painful procedure and most people will require very few painkillers. The stitches are removed after 2 weeks. The scar can initially be tender and it is advisable to massage the scar 2-3 times a day with a non scented oil or cream.  

Return to work and driving

You are advised not to drive whilst the stitches are in after an open carpal tunnel operation. Most people can return to non manual work after 2-3 weeks and heavier work by around  weeks.

After the keyhole operation most tasks can be done fairly normally by 2-3 days.

Risks

Any procedure carries risks and whilst every care is taken to minimise the chances the following are some of the more common - but still rare  - complications that can arise:

Infection - Significant infection is very rare

Tender scar - The scar is always a little tender but occasionally it takes longer and requires more treatment to settle.

Wrist pain - Some aching pain around the wrist - known as pillar pain is relatively common but nearly always resolves after a few months.

Stiffness, swelling and pain  - A degree of stiffness , swelling and pain following surgery is normal. Some people react badly to an operation and develop more of this. This in called complex regional pain syndrome (CRPS) and requires specialist treatment.

Nerve injury - This is vanishingly rare but it is risk whenever operating on or near a nerve - this is slightly more likely with the keyhole procedure.