Light at the end of the tunnel? Surgery for carpal tunnel syndrome

Carpal tunnel syndrome is a condition that can be painful and also may result in difficulty with grip. For those who rely on using their hands for their jobs, having it can be a particularly stressful circumstance both regarding quality of life and symptoms.

There are various solutions for carpal tunnel, and one that can offer help for those with immediately severe symptoms, or a final resort, is surgery. Here to explain how effective carpal tunnel surgery can be at the possibility of offering a light at the end of the tunnel, is leading consultant orthopaedic hand and wrist surgeon Mr Shahrier Sarker.

When is carpal tunnel surgery required?

The first thing that's important is, 'what is carpal tunnel syndrome?'. So, carpal tunnel syndrome is a condition which involves the median nerve in your wrist getting trapped. There's a multitude of causes.

If it reaches the stage where patients are getting symptoms such as pins and needles in their fingers, or numbness in their fingers, and non-surgical management such as splinting and steroid injections haven't worked, then surgery would be the next option.

Also, in patients that present with very severe symptoms at the start such as numbness in the fingertips that don't go away, or even wasting of the muscles at the base of the thumb, enough conduction tests show quite severe carpal tunnel syndrome, then surgery is usually required.

How is it performed?

Carpal tunnel surgery is usually performed under a local anaesthetic, so the patient comes into theatre and they have local anaesthetic injected into the palm of their hand. Then the operation takes about 10 to 15 minutes to perform on the patient. They can then go home, usually after the operation.

Another option is doing it via keyhole surgery. We call this endoscopic carpal tunnel decompression. It can be done with a smaller incision, just at the bottom of your palm, over the wrist crease, and it's done by inserting a camera underneath the ligament that's involved in carpal tunnel syndrome. Then using a blade that's deployed at the end of the camera to cut back and to release it. The benefit of that, is that's it's slightly quicker to return to work and have smaller scaring. That is usually performed either under a regional or general anaesthetic, and it takes about 25 minutes or half an hour to perform.

Is it safe? Are there any risks involved?

All surgery has risks involved. On the scale of things, it's a fairly safe procedure as long as the surgeon is experienced and knows what they're doing. There's a small, potential risk of damaging the nerve when you're doing the operation.

All surgical risks such as infection, swelling and pain are in consideration as well. Most patients will experience something called pillar pain, which is the pain on the sides of the incision after a carpal tunnel operation. This also happens even after an endoscopic carpal tunnel decompression, as the anatomy changes slightly after the operation.

Apart from that, there's always a risk of the operation not really working or not all symptoms going away because it depends on how badly damaged the nerve is prior to surgery. In general, it's a fairly straightforward and safe operation.

Who might not be suitable for this procedure?

I think most patients are suitable for this kind of procedure, as long as their symptoms warrant a need for a carpal tunnel decompression.

The only thing I advise patients who have very severe symptoms, such as numbness in the fingers, are that, after the operation, the numbness may not get better if it hasn't improved within 18 months.

It's still important to perform, even though they don't have much pain, or pins and needles, because it prevents the nerve from becoming more damaged. 

What is recovery time like?

The patient usually has a big, bulky dressing for about two days. And after two days they reduce it to a small dressing and then the stitches normally come out at about 12 to 14 days. After 12 to 14 days, they can start doing normal things, and getting it wet, as long as the wound has healed satisfactorily. It can take up to three months to be able to put full pressure on the palm and to lift up as there will be a bit of pain in that area. In general, most patients get back to their full activity usually between four to six weeks.

Arrange an expert appointment with Mr Sarker via his Top Doctors profile if you require surgery for carpal tunnel syndrome, or require an assessment.