Carpal Tunnel Release Surgery
Carpal tunnel release surgery is a decompression procedure that frees the median nerve compressed within the carpal tunnel at the wrist by dividing the transverse carpal ligament (flexor retinaculum). It can be performed with an open or endoscopic technique and aims to reduce the pain, numbness, and weakness caused by carpal tunnel syndrome.
Última actualización: 2026-06-09
Definition
Carpal tunnel release surgery is a microsurgical procedure that opens the roof of the carpal tunnel on the palmar side of the wrist and relieves pressure on the median nerve. When the transverse carpal ligament forming the roof of the tunnel is divided, the volume of the tunnel increases and pressure on the nerve decreases. The procedure can be performed through an open approach (a small palmar incision) or an endoscopic approach (camera-guided through one or two small portals); the essential goal of both methods is the same: complete release of the transverse carpal ligament.
Indications
Surgery is considered in patients with carpal tunnel syndrome confirmed by clinical findings and, when needed, electrophysiological testing (EMG / nerve conduction studies). It is generally offered to patients who have not responded, or have responded insufficiently, to an adequate trial of conservative treatment (night splinting, activity modification, anti-inflammatory medication, local corticosteroid injection). Findings such as progressive sensory loss, thenar muscle wasting (atrophy), or marked motor weakness may warrant earlier surgical evaluation. The indication relies on the symptoms matching the anatomical distribution of the median nerve.
Procedure
The procedure is usually performed under local anesthesia, a regional block, or light sedation, most often as a day case. In the open technique, a small incision is made in the palm just to the ulnar side of the thenar crease; the subcutaneous tissues and palmar fascia are passed, the transverse carpal ligament is directly visualized, and it is divided along its full length while protecting the median nerve. In the endoscopic technique, one or two small portals are created, and the ligament is visualized from beneath with a camera placed within the tunnel and cut with a dedicated blade. In both methods, complete release of the ligament and decompression of the median nerve are confirmed, hemostasis is achieved, and the incision is closed.
Advantages and Limitations
Carpal tunnel release is a well-defined procedure supported by long clinical experience and an extensive literature. The open technique allows direct visualization of the transverse carpal ligament and median nerve, providing a safe dissection. The endoscopic technique may offer smaller incisions with less early scar tenderness and the potential for faster return to work, but the field of view is more limited and it requires experience to reduce the risk of nerve injury. In advanced, long-standing nerve damage or in the presence of thenar atrophy, recovery may be partial; if there are additional concurrent nerve entrapments, it may not be sufficient alone.
Recovery and Risks
Recovery time varies by patient and by the operated hand; in many patients numbness and night pain begin to ease quickly, but full recovery of grip strength and palmar tenderness may take weeks. Possible risks include infection, bleeding, injury to the median nerve or the palmar cutaneous branch, scar-site tenderness (pillar pain), incomplete ligament division, and rarely recurrence of symptoms. In long-standing severe nerve damage, sensation or strength may not fully return. No outcome is guaranteed; the decision is individualized by considering the patient's clinical status, nerve conduction findings, and expectations together.
Referencias
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:546-553.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:2427-2431.
- American Academy of Orthopaedic Surgeons (AAOS). Clinical Practice Guideline: Management of Carpal Tunnel Syndrome.
Este artículo es informativo y no sustituye un examen médico. Las decisiones de diagnóstico y tratamiento son individuales.