Carpal Tunnel Release

Why this approach — at MOS

Carpal tunnel release is one of the most common procedures in hand surgery, but "common" does not mean routine in an imprecise way. The decision between open and endoscopic technique deserves a genuine discussion with each patient based on their specific anatomy, occupation, and recovery priorities.

For most patients who need to return to keyboard or light manual work quickly, endoscopic carpal tunnel release is our preferred technique. Published data consistently shows equivalent long-term outcomes to open surgery — the same nerve decompression, the same low recurrence rate — with faster return to work and fewer complaints of pillar pain in the immediate post-operative period. For patients with prior carpal tunnel surgery, those with thickened or scarred tissue, or when anatomy is uncertain, open release provides better visualization and is the safer choice.

Before recommending surgery, we confirm the diagnosis with nerve conduction studies. A positive electrodiagnostic study ensures we are treating the correct nerve at the correct level. It also rules out the conditions that mimic carpal tunnel syndrome — particularly cervical disc disease and pronator syndrome — which will not improve with carpal tunnel surgery.

It is important to distinguish carpal tunnel syndrome from cubital tunnel syndrome, a separate condition involving the ulnar nerve at the elbow. Cubital tunnel affects the ring and small fingers, not the thumb and index finger, and is treated with a different operation. Treating the wrong nerve produces no benefit. Thorough evaluation before surgery prevents that error.

Recovery support is available through MOS physical therapy, and Dr. Fitzgibbons coordinates hand therapy referrals for patients who need it.

Who is a candidate?

Indications

• Persistent or worsening numbness and tingling in the median nerve distribution (thumb, index, middle, and radial half of ring finger) despite at least 6–12 weeks of conservative treatment
• Nighttime symptoms that consistently disrupt sleep
• Weakness or atrophy of the thenar muscles (the muscles at the base of the thumb)
• Abnormal nerve conduction study (NCS) confirming median nerve compression at the wrist
• Severe or rapidly progressing nerve dysfunction requiring prompt surgical decompression
• Symptom recurrence after prior conservative treatment or corticosteroid injection

Contraindications

• Incomplete trial of conservative treatment in patients with mild symptoms
• Alternative diagnoses not yet excluded: cervical radiculopathy (pinched nerve in the neck), pronator syndrome, thoracic outlet syndrome, or polyneuropathy
• Active skin infection over the planned incision site
• Severe medical comorbidities that elevate anesthetic risk beyond the expected benefit
• Patient unwilling to comply with post-operative care or activity restrictions

Conservative Treatment First

Surgery is not the first step. For mild to moderate carpal tunnel syndrome, Dr. Fitzgibbons recommends a structured trial of non-surgical care before discussing an operation. Nighttime wrist splinting in a neutral position is the most effective first-line measure — it prevents the wrist from bending during sleep, which reduces nerve pressure. Corticosteroid injections directly into the carpal tunnel can provide significant, though often temporary, relief and serve as a useful diagnostic tool: if an injection works, surgery to decompress the same tunnel almost always will too.

Activity modification — reducing repetitive wrist flexion and vibrating tool use — and ergonomic changes to keyboard and workstation height can reduce daytime symptoms. Oral anti-inflammatory medications may ease soft-tissue swelling. Hand therapy can address contributing muscle imbalances. If these measures fail to produce lasting improvement over 6–12 weeks, or if symptoms are severe enough that nerve damage is progressing, surgery becomes the appropriate next step. Electrodiagnostic testing (nerve conduction study and electromyography) is standard before surgery and provides an objective severity baseline that guides the urgency of the recommendation.

The procedure

What Is Carpal Tunnel Release?

Carpal tunnel release is a surgical procedure that cuts the transverse carpal ligament to relieve pressure on the median nerve at the wrist. It treats carpal tunnel syndrome — numbness, tingling, and weakness in the thumb, index, and middle fingers — when non-surgical treatments have not worked.

The carpal tunnel is a narrow passageway on the palm side of the wrist, formed by the carpal bones on the bottom and sides and the transverse carpal ligament across the top. Nine flexor tendons and the median nerve pass through this tunnel together. When the tunnel becomes narrowed — due to swelling, repetitive use, anatomical variation, or systemic conditions such as diabetes or hypothyroidism — the median nerve is compressed. This compression is what causes the hallmark symptoms of carpal tunnel syndrome: nighttime hand numbness, tingling or burning in the thumb, index finger, middle finger, and part of the ring finger, and in more advanced cases, weakness in grip and pinch.

Carpal tunnel release divides the transverse carpal ligament, expanding the tunnel's volume and immediately reducing pressure on the nerve. The ligament does not need to be repaired — it heals in a lengthened position, and the extra space it creates is permanent. Two techniques are available: traditional open release, which uses a small incision in the palm, and endoscopic release, which uses one or two smaller incisions and a camera. Both achieve the same goal of complete ligament division, but they differ in incision size, recovery speed, and the risk profile. Dr. Fitzgibbons discusses both options with each patient and recommends the approach best suited to their anatomy, occupation, and hand-use requirements.

What Happens During Carpal Tunnel Release?

Setting and preparation: Carpal tunnel release is performed on an outpatient basis. You will arrive, be prepped, and go home the same day. In most cases, no general anesthesia is required — the procedure is done under local anesthesia, often combined with mild oral or IV sedation to keep you comfortable.

Positioning: You lie on your back with the arm extended on a padded arm board. A tourniquet is placed on the upper arm to maintain a bloodless surgical field. The hand and wrist are cleaned and draped.

Open technique: A 2–3 cm longitudinal incision is made in the palm, aligned along the thenar crease toward the wrist. The incision is carefully extended through the subcutaneous tissue to the transverse carpal ligament, which is then divided under direct vision from the distal (palm) end to the proximal (wrist) end. The surgeon confirms the median nerve is fully decompressed and inspects the nerve for any synovitis or abnormal tissue. The skin is closed with absorbable or removable sutures.

Endoscopic technique: One small incision is made at the wrist crease (single-portal) or one at the wrist and one at the palm (two-portal). A narrow cannula with a small camera is inserted, and the transverse carpal ligament is visualized on a monitor and divided with a specially designed blade — all from the inside, without opening the palm. The camera is removed, and the tiny incisions are closed. This approach preserves the palmar fat pad and reduces the risk of pillar pain — the aching some patients feel in the heel of the hand after open surgery — and typically allows faster return to gripping activities.

Recovery room: The arm is wrapped in a soft dressing. Most patients are discharged within one to two hours. Oral pain medication is prescribed for the first few days, though many patients report mild post-operative discomfort.

Recovery timeline

Frequently Asked Questions