Carpal tunnel syndrome occurs when the median nerve between the forearm and hand is compressed by swelling ligaments, causing a tingling sensation, weakness, and pain in the hand. Surgery for carpel tunnel syndrome relieves the symptoms by both separating the thick wrist ligament, called the transverse carpel ligament, and decreasing pressure on the median nerve. Complete recovery from carpal tunnel release is typically one to three months, but it can be as long as a year, depending on the type of surgery and whether complications occur. Common complications delaying recovery are caused by median nerve damage during surgery, and excessive swelling, scar tissue formation, and infection following surgery. Physical therapy, on the other hand, may shorten recovery time.
Carpal tunnel surgery can be performed as open or endoscopic surgery. Open carpel tunnel surgery involves making a 2-inch (about 5 cm) slit on the palm side of the wrist to access the transverse carpel ligament. In endoscopic surgery, one or two small incisions are made in the wrist through which tools are introduced to cut the wrist ligament. Both types of surgery are done under local anesthesia and do not require a hospital stay. Recovery from endoscopic carpal tunnel surgery is slightly shorter than for open surgery.
The median nerve goes through the carpal tunnel and then separates, spreading out across the hand. The pattern of nerve branching is not exactly the same for everyone, so occasionally the median nerve can be inadvertently damaged during surgery. Loss of feeling and function in the hand is the result. Endoscopic surgery has a higher frequency of nerve damage. If the median nerve is partially cut recovery is typically up to one year, and if it is severed, full recovery may not be possible.
Excessive swelling and formation of scar tissue can also prolong recovery from carpal tunnel surgery. The degree of swelling is variable, but excessive swelling can prolong the pain in the wrist for up to four months. Scar tissue formation, typically more of a problem with open surgery, can occur to such a degree that the wrist tendons and the median nerve are bound up, limiting wrist movement. Sometimes a second surgery is required to eliminate some of the scar tissue, prolonging recovery time by a few months while the second surgery heals.
Infections, though rare, can prolong recovery from carpal tunnel surgery by delaying the healing of the surgical wound. The length of delay varies depending on the infection and treatment. Usually, if an infection is caught early and treated quickly, it will not impact recovery for long. Being diligent about wound care and watching for signs of infection such as fever, increasing tenderness at the wound site, and wound discharge will help to catch infections early and prevent delayed recovery.
Physical therapy following carpal tunnel surgery is not always required by surgeons, but it may help speed up recovery. Therapy is typically started a few weeks after surgery, and focuses on increasing strength and mobility. Another benefit from physical therapy is greater use of the wrist, once the surgery has healed.