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Open-release surgery for carpal tunnel syndrome
By Mayo Clinic staffOpen-release operations allow the surgeon to view the carpal tunnel directly, without the aid of a camera. Many surgeons prefer this approach because it is technically simple, safe and effective. Open-release surgery can be done for anybody with carpal tunnel syndrome.
Open-release surgery may have some particular advantages if your doctor wishes to directly inspect the contents of the carpal tunnel. Your surgeon might wish to inspect or remove some of the carpal tunnel contents if:
- Your carpal tunnel or median nerve has unusual characteristics
- You also have rheumatoid arthritis or diabetes
- Your physical examination and imaging studies strongly suggest that a tumor is compressing your median nerve
- You've had previous wrist surgery
How is it done?
While general anesthesia isn't necessary for carpal tunnel surgery, you may be sedated during the procedure if you wish or if your surgeon is planning to do a more extensive operation than usual. Your doctor will numb the area with an injection. Some doctors inject the numbing medicine in your palm, while others target a bundle of nerves near your collarbone. A tourniquet may be placed on your arm to reduce the amount of blood flow to your hand. The entire procedure usually takes about 10 minutes.
Most open-release incisions are about 2 inches (5 centimeters) long. The standard incision starts in the middle of your palm and sometimes extends into your wrist. Some surgeons use a mini-incision about an inch (2.5 centimeters) long, in an effort to avoid scar tenderness, which tends to be worse in incisions that cross the wrist.
Recovery
Open-release carpal tunnel surgery is an out-patient procedure, so you should be able to go home later that same day. Some people need prescription pain medication for a few days, but then can switch to over-the-counter drugs such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol, others).
Your doctor may want you to wear a splint on the hand at night or for certain activities for the first two weeks after surgery, to protect your wrist while it heals. Unless your doctor tells you differently, don't lift anything heavier than 11 pounds (5 kilograms) for two months after surgery. For reference, a gallon of milk weighs roughly 8.5 pounds (4 kilograms).
Finger and wrist exercises typically begin immediately after surgery, to help prevent the nerve tissue and tendons from getting stuck in one position. The amount of rehabilitation you may need will vary, depending on the size of your incision and the severity of your symptoms. Most people won't need any formal physical or occupational therapy.
Results
Many people continue to have some carpal tunnel symptoms after surgery, but most report that the operation reduced their symptoms significantly. Grip strength is often reduced immediately after surgery, but usually rebounds within a few months. Your scar, however, may feel tender for up to a year. Massaging your scar can help desensitize it.
The time off work after carpal tunnel surgery depends on many factors. A right-handed factory worker with open-release surgery on the right hand and no option for light-duty work might be off work six weeks or more, while a left-handed executive with a right open-release surgery may not miss any time from work. Most people are off work for at least a month after open-release surgery.
At least 10 percent of the people who have either variety of carpal tunnel surgery never return to their original line of work — especially if their jobs involved heavy manual labor. Be sure to discuss return to work with your surgeon before surgery.
Endoscopic surgery for carpal tunnel syndrome Surgery for carpal tunnel syndrome
