Carpal Tunnel Decompression

What is Carpal Tunnel Decompression?

Carpal tunnel decompression — also called carpal tunnel release — is a surgical procedure that relieves compression of the median nerve at the wrist by dividing the transverse carpal ligament: the thick fibrous band that forms the roof of the carpal tunnel. Dividing this ligament immediately enlarges the tunnel, decompressing the median nerve and relieving the pain, numbness, tingling, and weakness characteristic of carpal tunnel syndrome.

Carpal tunnel decompression is one of the most commonly performed and most successful operations in peripheral nerve surgery — more than 90% of patients with carpal tunnel syndrome experience significant improvement or complete resolution of symptoms. It is performed at One Brain and Spine using both open and endoscopic techniques.

Open vs Endoscopic Carpal Tunnel Release

Both techniques achieve identical surgical goals and comparable outcomes. The choice depends on surgeon and patient preference:

• Open carpal tunnel release — through a 2 to 3cm palm incision; direct visualisation of the entire carpal tunnel; suitable for all cases including complex and revision surgery
• Endoscopic carpal tunnel release — through a small wrist incision less than 1cm; camera and instrument introduced through a working channel; equivalent outcomes with faster return to grip strength and reduced scar discomfort. This is One Brain and Spine's preferred technique for straightforward cases.

Preoperative Preparation

Nerve conduction studies (NCS) confirm median nerve compression at the wrist, assess severity, and exclude other diagnoses. Surgery is booked as a day case. Blood thinners are ceased. The procedure is performed under local anaesthesia (wide-awake technique) or general anaesthesia based on patient preference.

What Happens During Open Carpal Tunnel Release?

Under local or general anaesthesia, a 2 to 3cm longitudinal incision is made in the midpoint of the palm/wrist — centred over the carpal tunnel. The subcutaneous tissue is carefully divided, and the transverse carpal ligament is identified and completely divided under direct vision. The median nerve is inspected — confirmation of adequate decompression is made by the nerve's improved appearance and cushion of fat around it. The wound is closed with sutures. Duration: 15 to 30 minutes.

What Happens During Endoscopic Carpal Tunnel Release?

Under local or general anaesthesia, a small incision (approximately 1cm) is made at the wrist crease. An endoscopic system with a camera and slotted cannula is introduced under the transverse carpal ligament into the carpal tunnel. Under direct endoscopic vision, the ligament is divided from within the tunnel using a retractable blade — ensuring complete division without damaging the overlying skin or adjacent structures. The endoscope is withdrawn and the small wound closed with 1 to 2 sutures. Duration: 15 to 20 minutes.

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Outcomes of Carpal Tunnel Decompression

More than 90% of patients achieve good-to-excellent relief of carpal tunnel symptoms. Results are best when surgery is performed before significant thenar muscle wasting has occurred. Both open and endoscopic techniques achieve equivalent long-term outcomes — endoscopic technique may allow earlier return to grip-intensive activities.

Risks and Complications

• Scar tenderness — pillar pain in the palm adjacent to the incision; common after open surgery; less common with endoscopic technique; typically resolves within months
• Incomplete release — rare; requires revision surgery
• Nerve or vessel injury — rare; injury to the median nerve, palmar cutaneous branch, or palmar arterial arch
• Complex regional pain syndrome (RSD/CRPS) — rare (approximately 0.3%); persistent pain and hypersensitivity disproportionate to the procedure
• Wound infection — approximately 1%
• Recurrence — uncommon after complete release; may occur if the ligament reforms (rare) or if the nerve was incompletely released.