Carpal tunnel release: what happens, risks and recovery

Carpal tunnel syndrome comes from pressure on the median nerve as it passes through a narrow channel at the wrist. The usual picture is tingling, numbness and aching in the thumb side of the hand, often worse at night. Surgery is aimed at that pressure, not at the wrist as a whole.

Most people are not rushed to the operating theatre. The NHS lists a wrist splint worn at night, avoiding repeated wrist bending and gripping, and a steroid injection to calm swelling around the nerve. The NHS also notes the syndrome can come back after an injection, which is one reason some people eventually choose an operation.

Surgery becomes a reasonable conversation when symptoms keep returning, when sleep or work is badly affected, or when examination or nerve tests suggest the nerve is being squeezed enough to risk lasting numbness or weakness. If the diagnosis is unclear, the NHS says nerve conduction testing or imaging may be arranged first.

Milton Keynes describes splints and steroid injections as treatments that ease symptoms without changing the underlying narrowing. That framing is useful: they can buy comfortable months, and for some people that is enough, but they are not a repair.

• A night splint keeps the wrist straight while you sleep. The NHS says it can take up to 6 weeks of wearing it before symptoms start to ease.

• Activity changes, such as breaking up repetitive gripping tasks, can reduce flare-ups.

• A steroid injection near the nerve can settle swelling. Ask how long benefit lasted for people in similar situations and what happens if it wears off.

• Painkillers such as paracetamol or ibuprofen may help in the short term but do not treat the cause.

Fasting instructions depend on the anaesthetic your hospital plans, so your own letter decides this. Read the admission letter and ask if it is unclear. Tell the team about blood thinners, diabetes and any skin problems on the hand.

Wear short sleeves or loose sleeves that push up easily, remove rings from the operated hand, and plan how you will manage at home with one hand bandaged. Arrange a lift home, because gripping a steering wheel straight afterwards is not realistic.

You arrive, are checked in, and the arm is cleaned and marked. Local anaesthetic is injected near the wrist. According to Milton Keynes you are awake and may feel pulling in the hand but no pain, and it also says it may take several hours before feeling comes back afterwards.

Milton Keynes describes an open approach: a cut is made on the palm, and the fibrous layer over the nerve is divided so the nerve is freed. The wound is closed, a dressing and bandage go on, and you are encouraged to keep the hand raised and move the fingers. The NHS says no overnight stay is expected.

Most of the downsides described in the leaflets are modest. Milton Keynes lists scar pain, which it says typically settles within three months with massage, and a low risk of infection. It also warns that numbness or weakness present before surgery may not fully recover, particularly if the nerve has been squeezed for a long time.

Hull University Teaching Hospitals notes that occasional stabbing pain, scar pain and aching when gripping can persist for three to four months. Contact the team if there is redness, increasing pain, discharge, heavy bleeding or growing stiffness. None of the retrieved pages gave percentage risks, so none are quoted here; ask your surgeon for figures that reflect their own results.

Hull advises removing the bandage two to three days after surgery, keeping the wound clean and dry for at least 48 hours, and leaving a small plaster on for up to ten days. It also describes massaging the scar with a simple moisturising cream twice daily for at least six weeks.

The hand should be moving normally within about two weeks according to the same leaflet. For a week-by-week view, see the separate recovery timeline linked below.

Spreading redness, a wound that is leaking, a fever or pain that keeps climbing should be reported the same day to the hospital team that treated you or your GP, or to NHS 111 when those are closed. Heavy bleeding that does not stop with firm pressure and a raised hand needs urgent help. Call 999 for sudden chest pain or breathlessness.

• Is my nerve compression confirmed by tests, or is the diagnosis clinical?

• Will you use an open or a keyhole approach, and why?

• What should I do about stitches, and who will remove them if needed?

• When do you expect my night-time symptoms to improve?

• What happens if the numbness does not go away?

The operation is the same in both settings. Differences tend to lie in waiting time, how much choice you have over the surgeon and the date, and whether a hand therapist follows you up. Ask what the package covers if the other hand needs surgery later or if you need a repeat appointment.