Carpal Tunnel Surgery - Carpal Tunnel Release

All carpal tunnel release procedures cut the transverse carpal ligament, pictured above.

Carpal Tunnel Surgery Overview

Carpal Tunnel Surgery has been performed since the 1960’s.  Called a Carpal Tunnel Release it is a popular and common procedure.  In the United States roughly 600,000 patients have a carpal tunnel release surgery each year.  It is considered a high success rate surgery in that the vast majority of patient have excellent outcomes and report long term relief of symptoms and high levels of satisfaction.  Complications can occur but are quite rare – around 1% of patients.

Carpal tunnel surgeries are often perform by orthopedic surgeons, neurosurgeons, plastic surgeons, hand surgeons, and interventionists.

The Carpal Tunnel Surgery Mechanics

All procedures aim to access and transect (cut) the transverse carpal ligament – also known as the flexor retinaculum.  The three different procedures have different ways of accessing and cutting the ligament and thus have markedly different recovery times. The cutting the transverse carpal ligament typically relieves pressure on the median nerve, which alleviates carpal tunnel symptoms and is why the procedure is called a carpal tunnel “release.” Afterwards, the cut section of the ligament heals over with scar tissue and becomes whole again.  The healed ligament is longer than before the surgery and should not compress the median nerve.

Three Different Carpal Tunnel Release Procedures

Capal tunnel treatment - carpal tunnel surgery

Patient hand immediately after a minimally invasive carpal tunnel release surgery using CODA CTR.

1. Ultrasound Guided, Percutaneous Carpal Tunnel Release

Known under the brand names CODA CTR or MANOS CTR this is the least invasive procedure on the market by a wide margin.  Because there is so little surgical trauma it offers a fast recovery time. Many patients return to work the same week of surgery. Patients like this procedure so much we gave it its own dedicated page.

Learn about CODA CTR and MANOS CTR here.

Key benefits:

  • If bilateral, treat two hands during one surgery visit.
  • Local anesthesia (stay awake)
  • No tournaquet required
  • Minimally invasive – 2mm wrist puncture
  • No incision, No stitches
  • No splint required
  • Fast Recovery Time

2. Open Carpal Tunnel Release (OCTR) Surgery

Open Carpal Tunnel Release Stitches

Stitches after an Open Carpal Tunnel Release. Many patients now choose a less invasive procedure. You can avoid stitches and scars by having Carpal Tunnel Release with CODA CTR™ or MANOS CTR™ procedure.

For an open carpal tunnel release a surgeon normally will use a tourniquet to restrict bleeding during the surgery. Because of the pain from both the tourniquet and the incision general anesthesia is commonly used during an open carpal tunnel release.
For a standard open carpal tunnel release the surgeon will make a two to three inch incision in the wrist and palm. The surgeon then cut through the palmar fascia and other subcutaneous tissue to access to the transverse carpal ligament. The surgeon will then cut the ligament to relieve pressure on the median nerve. The incision on the hand is then closed with stitches, after which it is typically wrapped in a heavy bandage and braced in a hand splint.

The incision often leaves a scar. Patients may experience pain, tenderness, and sensitivity at the incision site for a number of months. Postoperative care can includes office visits for wound car, the removal of stitches, administering of pain medication, hand bracing, and hand rehab or physical therapy.

The average return to work time for open carpal tunnel surgery is 54 days.1

3. Endoscopic Carpal Tunnel Release (ECTR) Surgery

Endoscopic carpal tunnel release has been in use since the 1990’s. It was introduced by surgeons who thought it was beneficial to eliminate the palmar incision used in open surgery. The purpose of the new method was to reduce surgical trauma and thus reduce scarring and patient recovery times.

For an endoscopic carpal tunnel release a surgeon will make one or two half-inch incisions in the wrist and/or palm. Endoscopes (small cameras) are often 10 to 12 millimeters in diameter, so often a surgeon will insert a dilator into the incision(s) to create enough space in the carpal tunnel for the endoscope and other instruments. Afterwards the surgeon inserts an endoscope into the carpal tunnel. Once has the transverse carpal ligament has been visualized on screen, the surgeon will insert an instrument to cut the ligament.

Stitches are generally used to close the incision(s). There is normally less scarring compared to an open carpal tunnel release surgery, but many patients often have visible scars. Postoperative care is similar to open surgery but can vary based on the endoscopic system used.

The endoscopic carpal tunnel release procedure has not been widely adopted, even though it is widely accepted by surgeons as a safe and effective alternative to open surgery. Several clinical studies noted an increased risk of complication with endoscopic carpal tunnel release surgeries. Today, only about 15% of carpal tunnel release surgeries are performed endoscopically in the U.S. Recovery time is often faster than with open surgery with an average return to work time of 28 days.1

Common Carpal Tunnel Surgery Misconceptions

Carpal Tunnel Surgery Myth #1: It takes a long time to recover from carpal tunnel surgery.
Truth: While the traditional, open surgery can take 6 weeks to heal, newer minimally invasive carpal tunnel surgery procedures can heal in just days.

Carpal Tunnel Surgery Myth #2: Carpal tunnel surgery doesn’t work or isn’t effective.
Truth: Carpal tunnel surgery has a success rate of over 90%. It is considered a highly effective surgery with the vast majority of patients experiencing complete relief of carpal tunnel symptoms. Patients who still have symptoms after surgery: 1) Had severe carpal tunnel or nerve damage prior to surgery, 2) had an incomplete release during surgery, or 3) did not have carpal tunnel syndrome in the first place.

Carpal Tunnel Treatment    CODA CTR / MANOS CTR

1. Source: Trumble TE, Diao E, Abrams RA, Gilbert-Anderson MM. J Bone Joint Surg Am. 2002;84:1107-15 “Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial.”