What is carpal tunnel syndrome?
One of the main nerves to the hand, the median nerve, passes from the forearm into the hand through a tight tunnel at the wrist formed by bones and a ligament. This is the carpal tunnel. If the nerve becomes squashed, it stops working properly, causing pins and needles, numbness or weakness in the hand.
Treatment options
Wrist splints
If your symptoms come and go, for example pins and needles only at night, a simple splint can be enough.
Steroid injection
If your symptoms are more frequent or constant, a steroid injection into the carpal tunnel can help. This is done in the outpatient clinic.
Surgery
Most people eventually need surgery. The aim is to divide the ligament over the carpal tunnel, giving the nerve more space and relieving the pressure. If the nerve is already scarred, not all symptoms may go, but the operation should stop them getting worse.
Open or endoscopic surgery?
Surgery is usually a day case, done with you awake and the area numbed by a local anaesthetic injection. The injection stings briefly, but once it works you won’t feel pain.
In a traditional open release, the incision is made in the palm and may extend slightly into the forearm. In an endoscopic release (ECTR), the incision is made at the wrist instead. A small camera (endoscope) is used to see the ligament from inside, and it’s divided without cutting the skin of the palm.
| Endoscopic release | Open release | |
|---|---|---|
| Incision | At the wrist | In the palm |
| Both hands at once | Yes, safely | Usually not |
| Return to work | On average 8–14 days sooner | Standard |
| First 3 months | Less pain, better grip strength | Standard |
| Complication rates | The same | The same |
Patients who have endoscopic release are, on average, more satisfied.
Risks and possible complications
Complication rates are the same for endoscopic and open release. Risks include, but are not limited to:
- infection, needing antibiotics or further surgery
- bleeding
- a sensitive or tender scar needing further treatment
- delayed wound healing, needing dressings
- injury to the median nerve, causing permanent numbness or weakness
- incomplete or slow relief of symptoms
- complex regional pain syndrome, which makes the hand painful and stiff and needs intensive hand therapy. This is very rare, affecting about 1 in 3,000 people having any hand surgery or treatment
After your operation
For the first week, use your hand as pain allows, but avoid strong gripping such as driving or lifting heavy things. You can wash and shower from the first day; replace the dressing with a plaster if it gets wet. Avoid soaking in the bath for a week and swimming for two weeks. The stitches dissolve and don’t usually need removing.
If your hand becomes too painful or stiff to use, please contact us, as you may need hand therapy to help it recover.
Page last updated October 2026.