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Carpal tunnel release (open)
A day-case procedure to relieve pressure on the median nerve at the wrist – often performed wide awake under local anaesthetic, or alternatively with sedation or a general anaesthetic.
Anaesthetic
Can be performed under local anaesthetic alone, or sedation or general anaesthetic at The Avenue Hospital
Where
The Avenue Hospital
Day case
You go home from hospital that day
First post operative review
Approximately one week after surgery
Driving
Plan not to drive for two weeks after the procedure, although many patients report they are able to drive earlier
Post Operative Hand Therapy
Optional; routinely recommended for Workcover patients to assist in return to work planning
Splinting
No
Pain relief
Usually paracetamol and/or ibuprofen
Return to repetitive & heavy loading
At least 6 weeks after surgery
What is open carpal tunnel release?
Open carpal tunnel release is an operation to relieve pressure on the median nerve where it passes through the carpal tunnel at the wrist. During the procedure the transverse carpal ligament – the tough band that forms the roof of the tunnel – is divided. This makes more room within the tunnel and relieves the compression on the nerve. It is one of the most common and reliable hand operations.
At Melbourne Hand Surgery we perform carpal tunnel release using both the open and endoscopic (keyhole) methods. This page describes the open technique; Dr Tomlinson will discuss the benefits and risks of each method with you so you can decide together which is right for you.
Who is open carpal tunnel release suitable for?
- People with carpal tunnel syndrome confirmed by their symptoms and examination, often supported by nerve conduction studies
- People whose symptoms have not settled with non-surgical measures such as splinting, activity changes or a corticosteroid injection
- People with severe or longstanding symptoms - including persistent numbness or wasting of the thumb muscles - where surgery is recommended sooner rather than later
- People who take anticoagulant (blood-thinning) medication: Dr Tomlinson does not routinely cease any anti-coagulant medications prior to open carpal tunnel release
- People who wish to have the procedure performed under local anaesthetic alone; Dr Tomlinson does not offer endoscopic carpal tunnel release under local anaesthetic
Whether the open or endoscopic method suits you best depends on your circumstances. The endoscopic method is felt to give a quicker recovery for individuals who perform light loading tasks, which can be particularly relevant if both hands are treated at the same time. However, as the surgery requires that a ligament be completely cut to be successful, you are not likely to notice any faster recovery from the endoscopic technique when it comes to heavier manual tasks and loading. Dr Tomlinson will talk you through the options at your consultation.
What does open carpal tunnel release surgery involve?
Through a small incision in the palm, Dr Tomlinson divides the transverse carpal ligament under direct vision, releasing the pressure on the median nerve. Because the ligament is divided, the tunnel is enlarged and the nerve has more room. The skin is then closed with absorbable sutures and a dressing is applied. You are discharged home that day.
The local anaesthetic generally lasts 6-24 hours, during which your hand and fingers will feel numb. Occasionally the local anaesthetic lasts as long as 72 hours. Until the local anaesthetic wears off you should not lift or grip with the hand, as you will not be able to sense if you are causing pain (injury).
Open carpal tunnel release can be performed as wide awake hand surgery – using local anaesthetic only – so you do not necessarily need sedation or a general anaesthetic. If you would prefer to be asleep or sedated, we can absolutely provide you with that option. If you take anticoagulant medication for a serious medical condition, Dr Tomlinson will not routinely cease or modify this for your procedure.
Your post operative review is usually 1 week after surgery, when your wound and dressing are checked, and we provide you with further advice and information about the recovery process.
Alternatives to surgery
Surgery is one option for carpal tunnel syndrome. Depending on your situation, the alternatives may include:
- Observation: mild or intermittent symptoms can sometimes be monitored without treatment.
- Night splinting: wearing a wrist splint at night can relieve pressure on the median nerve and ease symptoms, particularly for mild or early disease.
- Corticosteroid injection: can relieve symptoms, especially in mild or early cases, though the relief may be temporary. Is performed by a radiologist under ultrasound guidance.
- Activity or ergonomic modification: adjusting repetitive hand movements or workstation setup can help reduce symptoms in some cases.
Dr Tomlinson will discuss which options may suit your specific situation at your consultation.
Watch: Understanding carpal tunnel syndrome
Frequently Asked Questions
Where will my surgery be done?
Why might I choose local anaesthetic rather than sedation or a general anaesthetic?
A procedure under local anaesthetic avoids the risks and recovery of sedation or a general anaesthetic. You don’t need to fast beforehand, you can eat and drink normally, you recover quickly, and you usually go home soon afterwards. For many people it’s also less expensive and more convenient.
How much time will I need to have away from work?
This depends on what your job involves. If your work is desk-based or administrative, you may be able to return relatively soon, often with some temporary modifications. If your work is physical – heavy lifting, manual labour or “on tools” – you’ll usually need at least six weeks before you can resume heavy tasks.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for two weeks after the procedure.
When can I do a full day of administrative or desk work?
Often from 2 weeks after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication – your anaesthetist will give you specific instructions. If your procedure is under local anaesthetic only, fasting is generally not required.
How long will I need to wear a splint?
Dr Tomlinson does not splint patients after carpal tunnel release.
Will I need to see a hand therapist afterwards? May I see one if I'd like?
It isn’t essential for this procedure, but you’re welcome to see a hand therapist if you’d find it helpful. Dr Tomlinson can arrange a referral either way. Dr Tomlinson does recommend that all Workcover and TAC patients see a hand therapist after surgery to assist with return to work planning and recovery.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and if your carpal tunnel release surgery is combined with another procedure you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
In addition to the general risks of hand surgery, this specific procedure includes the risks of
- injury to the median nerve at the time of surgery
- incomplete relief of symptoms
- Persistent numbness or weakness in severe, longstanding cases, where the nerve may not fully recover
- Scar tenderness or “pillar pain” (tenderness on either side of the scar), which usually settles with time
- Recurrence of symptoms (uncommon)
Anaesthetic
If you are having sedation or a general anaesthetic for this procedure, your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time. If you had experienced nerve-compression pain prior to surgery it generally resolves quickly after the surgery, because blood flow to the nerve is restored. Take simple analgesic medication as needed. Place a plastic bag over your bandage when showering to keep it dry.
First week
Keep the dressing dry and intact until your post-operative review. You may use your hand for light activities, but listen to your hand and avoid anything that causes pain, such as lifting or gripping. Scar sensitivity and discomfort with lifting and gripping are expected in the first few weeks. Listen to your hand and do not perform activities that cause discomfort. After the first few days you should find that your hand function is better each day.
Second week
You should find that each day you have greater use of your hand - unless you overload your hand and make it sore. Most people cannot drive for at least one week; we recommend planning not to drive for two weeks. If you can take 10-14 days off work, that's recommended. If your work involves heavy manual labour, you may need light or alternative duties for up to 12 weeks - your restriction period depends on what you use your hand for.
6 weeks
Full grip strength may take several months to return, and deep-pressure tenderness over the wound can persist for some months. Nerve regeneration and healing continues. The scar will feel tight and firm. Massage assists with improving scar mobility and minimising scar firmness.
3 months
The scar firmness will start to resolve after 3 months, and will take up to 12 months to settle. Nerve regeneration and recovery of strength continues.
Long term
Hand strength returns to normal levels in the long term. Nerve regeneration and healing continue over 6-12 months. If you've had numbness for a long time it may take weeks to months to improve, and in severe, longstanding cases the nerve may not fully recover.
Want to know more about open
carpal tunnel release surgery?
Contact us to schedule an appointment with Dr Tomlinson.