What you need to know before carpal tunnel release surgery

Carpal tunnel release surgery aims to reduce pain and improve function for people with carpal tunnel syndrome. It's a common surgery, which in most cases relieves symptoms and prevents permanent nerve damage.

Carpal tunnel syndrome is a condition caused by increased pressure on the nerve that crosses the front of the wrist (the median nerve).

The median nerve runs through the carpal tunnel, a channel in the palmar side (the front or palm-side) of your wrist.

Some health conditions and activities can lead to swelling within the carpal tunnel, which narrows it and puts pressure on the median nerve, one of 3 nerves important for sensation and muscle control of your hand.

Carpal tunnel syndrome is most common in people who use their hands in repetitive actions (usually at work), pregnant women and those with diabetes or rheumatoid arthritis.

Symptoms include:

• tingling or burning sensations
• numbness and clumsiness
• pain, specifically at night.

If left untreated, symptoms can worsen over time, affecting how you use your hands and fingers. While treatments like exercises, improved ergonomics at work and some medications may help, surgery is recommended if symptoms don't improve.

It's recommended you do the following to prepare for surgery:

• Stop smoking and reduce or stop drinking alcohol.
• If you have diabetes, make sure it's well controlled. This can reduce any complications and improve your body's ability to heal.
• Ask family and close friends for help after your surgery. You'll need support lifting heavy items like groceries or looking after an active toddler. Doing too much, too soon can delay your recovery and impact your overall results.

Carpal tunnel release surgery is a minor procedure which is performed under a general or local anaesthetic. The operation to relieve the pressure on the median nerve usually takes less than 20 minutes.

Your surgeon reduces the pressure on the median nerve by releasing the ligament that is pressing down on the carpal tunnel.

You will have a small wound that will be stitched and well-bandaged. Some surgeons may offer keyhole surgery for the procedure, but this is less common.

In most cases, you should be able to go home the same day as your surgery if there are no complications.

After surgery, your hand will be in a bulky bandage. This means you'll have to stick to light activities like reading, typing on a computer and lifting a cup of tea or coffee until your wound has healed.

You'll need to plan how you'll manage daily activities (especially any heavy lifting) during this time.

This may be particularly hard if you don't have a support network or if you have caring responsibilities.

If you don't have access to a support network who can help during this time, try looking into local support services who can help carry the load. It's also a good idea to prepare some meals in advance and put them in the freezer, and to set up an online shopping order.

It's important you don't compromise your recovery by doing too much, too quickly.

In most cases, carpal tunnel release surgery successfully relieves the pain from carpal tunnel syndrome.

Talk to your doctor if you have:

• ongoing symptoms
• pain and redness that may indicate an infection
• pain travelling up your shoulder.

After surgery, it's vital to take the time to rest and recover, so be kind to yourself.

For the first 2 weeks after the procedure, a physiotherapist will give you mobility exercises to help bring back a full range of motion. This should be done gently while your incision heals. Getting back your movement is the first step to recover the full function of your hand.

Nerves that have been compressed for a long time are slow to recover. Pushing yourself too hard and too soon may be damaging and may compromise your recovery, so be patient and go at a sensible pace.

Some people may experience a side-effect called pillar pain for 4 to 6 weeks after their surgery. This is when you feel pain over the scar when you grip something or put pressure on your hands. This will usually go away by the 3-month mark, but it may be helpful to see a hand therapist for some targeted exercises, stretches and other treatments to reduce the pain.

Not everyone who has carpal tunnel release surgery will need to see a hand therapist, but if there is a specific issue relating to improving range or function, your surgeon may recommend it.

A hand therapist is a physiotherapist or occupational therapist who treats conditions specific to the upper limb (not just the hand). They have extensive knowledge and skills in understanding and treating problems with fingers, hands, wrists, elbows, and shoulders.

Your treating team will determine how many sessions you need. This may be influenced by how you recover and how often you do your exercises.

Remember, surgery is just one part of the journey. The right balance of rest and regular rehabilitation work will give you the best chance to recover as quickly as possible.

Australian Physiotherapy Association Musculoskeletal Physiotherapists focus on injuries to joints, muscles, bones and/or nerves.

Musculoskeletal physiotherapists have undergone further training and are regarded as experts in the assessment, diagnosis and management of musculoskeletal injuries like neck and back pain, and shoulder, hip and knee injuries.