Carpal tunnel decompression is a procedure to relieve pressure on the median nerve as it passes through the carpal tunnel at the wrist. It is the most commonly performed peripheral nerve operation in orthopaedics and hand surgery.
The operation is usually performed under local anaesthetic as a day-case procedure. The surgeon makes a small incision in the palm of the hand, over the carpal tunnel. The transverse carpal ligament (the roof of the tunnel) is divided to relieve the pressure on the nerve beneath. The skin is closed with stitches and a light dressing is applied. The procedure typically takes 15 to 20 minutes.
Surgery is recommended when carpal tunnel syndrome causes persistent or worsening symptoms — typically numbness, tingling, and pain in the thumb, index, and middle fingers — that have not responded to non-operative treatment, or when nerve conduction studies show significant compression. It is particularly important to consider surgery if there is muscle wasting or constant numbness.
Mild cases may respond to wrist splinting (especially at night), activity modification, corticosteroid injection into the carpal tunnel, and anti-inflammatory medication. Surgery is generally recommended when symptoms are persistent, progressive, or when nerve compression is confirmed on testing.
As this is usually a day-case procedure under local anaesthetic, preparation is straightforward. Eat and drink normally unless otherwise advised. Inform your surgeon about any blood-thinning medications. Remove rings and jewellery from the affected hand. Arrange for someone to drive you home.
The aim is to relieve the numbness, tingling, and pain caused by nerve compression. Night-time symptoms often improve within days. Numbness in the fingers may take weeks or months to resolve, and recovery is usually more complete when surgery is performed before symptoms become severe. In cases with advanced nerve damage, some residual numbness or weakness may persist.
Common in the palm and usually settles over weeks to months.
Normal in the early recovery period and improves with use.
Aching in the heel of the hand on either side of the scar. Can persist for several weeks.
Small risk, generally manageable with antibiotics.
Injury to the median nerve or its branches is rare but could cause numbness, weakness, or chronic pain.
Uncommon but may require repeat surgery if symptoms persist.
A rare complication causing prolonged pain, swelling, and stiffness.
Damage to the tendons within the carpal tunnel is very rare.
Most commonly performed under local anaesthetic injected into the palm and wrist. You will be awake during the procedure but should not feel pain. Some units offer regional anaesthesia (arm block) or, rarely, general anaesthesia.
Move the fingers and wrist gently from the day of surgery. The dressing is usually reduced after a few days, and stitches are removed at 10 to 14 days. Most people return to light activities within a week and to full duties within four to six weeks. Heavy manual work may take longer. Driving is usually possible once you can grip the steering wheel comfortably.
A wound review is usually arranged at 10 to 14 days for suture removal. Further follow-up depends on recovery. Most patients do not require formal physiotherapy.
Recurrence after surgery is uncommon. If symptoms return, it is usually because of scarring around the nerve rather than re-narrowing of the tunnel.
Night-time tingling often improves within the first few days. Numbness may take several weeks or months to resolve.
It is possible, but most surgeons recommend one hand at a time so you retain full use of the other during recovery.
A rigid splint is not usually necessary. A bulky dressing is applied after surgery. Your surgeon will advise if a splint is recommended.