What is Open Carpal Tunnel Release

Open carpal tunnel release is a surgery to relieve symptoms caused by carpal tunnel syndrome. The carpal tunnel is a narrow, hollow space in the wrist. It is located between the wrist bones and a band of connective tissue (transverse carpal ligament, also known as the flexor retinaculum).

The nerve that supplies most of the hand (median nerve) passes through the carpal tunnel, and so do tissues that connect bones to muscles (tendons) in the hand and arm. Carpal tunnel syndrome makes this space swell and become narrow. The swelling pinches the median nerve and causes pain and numbness.

During carpal tunnel release surgery, the transverse carpal ligament is cut to make more room in the carpal tunnel space. This also lessens the pressure on the median nerve. You may have this surgery if other types of treatment have not relieved your carpal tunnel symptoms. This surgery is usually done only for the hand that you use more often (dominant hand), but it may be done for both hands depending on your symptoms.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Injury to the median nerve.
• Allergic reactions to medicines.
• The surgery failing to relieve your symptoms, or making your symptoms worse.

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• You may be given antibiotic medicine to help prevent infection.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your arm, hand, and wrist will be cleaned with a germ-killing (antiseptic) solution.
• An IV will be inserted into one of your veins.
• You will be given one of the following:
  • A medicine to numb the wrist area (local anesthetic). You may also be given a medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• An incision will be made in your wrist, on the same side as your palm.
• The skin of your wrist will be spread to expose the transverse carpal ligament.
• The transverse carpal ligament will be cut to make more room in the carpal tunnel space.
• Your incision will be closed with stitches (sutures) or staples.
• A bandage (dressing) will be placed over your wrist and wrapped around your hand and wrist.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• A splint or brace may be placed over your dressing, to hold your hand and wrist in place while you heal.
• Do not drive until your health care provider approves.

Summary

• Carpal tunnel release is a surgery to relieve pain and numbness in the hand caused by swelling around a nerve (carpal tunnel syndrome).
• You may have this surgery if other types of treatment have not relieved your carpal tunnel symptoms.
• During carpal tunnel release surgery, a band of connective tissue (transverse carpal ligament) is cut to make more room in the carpal tunnel space.

Care After Open Carpal Tunnel Release

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Wrist stiffness.
• Bruising.

Follow these instructions at home:

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers.
• Keep your bandage (dressing) dry until your health care provider says it can be removed.

If you have a splint or brace:

• Wear the splint or brace as told by your health care provider. You may need to wear it for 2–3 weeks. Remove it only as told by your health care provider.
• Loosen the splint or brace if your fingers tingle, become numb, or turn cold and blue.
• Keep the splint or brace clean.
• If the splint or brace is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your dressing. If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain, stiffness, and swelling

• If directed, put ice on the affected area. 
  • If you have a removable splint or brace, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling. 
• Raise (elevate) your wrist above the level of your heart while you are sitting or lying down.

Activity

• Do not drive until your health care provider approves.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Return to your normal activities as told by your health care provider. Avoid activities that cause pain.
• If physical therapy was prescribed, do exercises as told by your therapist. Physical therapy can help you heal faster and regain movement.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
  • Take an over-the-counter or prescription medicine for constipation.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider and physical therapist. This is important.

Contact a health care provider if:

• You have redness or swelling around your incision.
• You have fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have a fever.
• You have chills.
• You have pain that does not get better with medicine.
• Your carpal tunnel symptoms do not go away after 2 months.
• Your carpal tunnel symptoms go away and then come back.

Get help right away if:

• You have pain or numbness that is getting worse.
• Your fingers or fingertips become very pale or bluish in color.
• You are not able to move your fingers.

Summary

• It is common to have wrist stiffness and bruising after a carpal tunnel release.
• Icing and raising (elevating) your wrist may help to lessen swelling and pain.
• Call your health care provider if you have a fever or notice any signs of infection in your incision area.