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Carpal Tunnel Syndrome

On this page:

1. What is Carpal Tunnel Syndrome (CTS)?

Carpal Tunnel Syndrome (CTS) is the name given to a group of symptoms which are caused by pressure on the median nerve. This nerve travels down the arm and supplies sensation to the thumb, the index, middle and half the ring finger. It also controls some movements of the thumb. At the wrist it travels through the carpal tunnel, which it shares with the tendons which bend the fingers. Typical symptoms are numbness, pins and needles and pain in the hand, which is often worse at night or with repetitive movements.

Carpal Tunnel Syndrome is sometimes associated with hormonal changes such as pregnancy or an under-active thyroid. In most cases no specific cause is known, but previous trauma or cysts may cause swelling of the tunnel which presses on the nerve.

Treatment for mild symptoms may be to use a splint or have a cortisone injection. If these do not work or the symptoms come back, surgery can be performed. This involves dividing the carpal ligament on the upper surface of the tunnel, to take the pressure off the nerve.

The position of the median nerve in the wrist
The median nerve travels down the arms, through the wrist and into the hand.
The part of the hand usually affected in CTS
The median nerve supplies sensation to the thumb, the index, middle and half the ring finger. These are the areas usually affected in CTS.

2. Carpal Tunnel Decompression Surgery

In this video, Dr Jon Williams explains more about what carpal tunnel decompression surgery involves.

Before the operation

We will see you in a clinic to explain the operation in more detail and answer any questions. If you are happy to go ahead you will sign a consent form. We will then make arrangements for the operation (usually within 1 month). It is sometimes possible to have the operation on the same day as the outpatient appointment – please let us know beforehand and we will try to make a suitable arrangement.

Please let us know if you are taking any blood thinning drugs (such as aspirin, warfarin, clopidogrel) and if you have any allergies.

On the day

  • You can have a light breakfast or lunch before the operation.
  • Buy suitable painkillers such as paracetamol or ibuprofen to take afterwards.
  • Wear a loose sleeved top to help get your hand in and out of your clothes.
  • Please make arrangements to get home as you cannot drive after the operation nor use your hand properly for 10-14 days.
  • Please remove any rings which are on the hand.

About the operation

You will be awake during the procedure. The surgeon gives you an injection into the hand to make it numb. They then make a cut in the palm about 2 inches long to reach the carpal ligament, which lies on top of the median nerve. The ligament is then divided to give the nerve more room.

The wound is closed with stitches and a large bandage is then applied. You will go home with your arm in a sling.  

A cross section of the carpal tunnel
A cross section of the carpal tunnel. The carpal bones form the floor and sides of the tunnel. The carpal ligament forms the roof of the tunnel. The median nerve is located in the space in the centre of this tunnel.

After the operation

  • After your operation it usually takes an hour for the local anaesthetic to wear off.  However, it is not unusual for you to still have some effects of tingling as if the anaesthetic is still working for up to a day.  Do not be alarmed by this.  
  • Please take some painkillers in this time.  You will need to take pain killers for a few days after the operation.
  • After your operation you will find that the pain in your hand is relieved by elevating your hand.  In order to help you with this we will give you a sling.  Most people use the sling for the first 2 days.
  • It is very important that you keep your fingers and thumb moving from immediately after your operation.  It is also important that you take the sling off to move your elbow and shoulder. We will suggest some exercises for you to do.
  • You should increase the hand movement each day so that you can do most things by 2 weeks.
  • You can drive once you can make a firm fist.
  • You can remove your dressing 8 days after the operation.  You can now get the wound wet, but do not soak it.  Apply Vaseline or equivalent twice a day. Continue with the hand and finger exercises.
  • Your stitches need removing 10-12 days after your operation at your GP surgery.  Please book an appointment with your practice nurse for this.
  • Going back to work depends on your job but most people are back after 2-3 weeks.
  • You will be seen for a follow-up appointment after about 6 weeks.
  • It usually takes up to 6 months for full recovery – occasionally it is longer if your symptoms were severe.


The speed of recovery from carpal tunnel surgery can be markedly variable.  There are multiple factors for this and, in fact, it is unusual to have patients having the same recovery in both hands when they have had both hands operated on by the same surgeon.  The usual expectations would be for you to be able to only carry out light duties and non-repetitive tasks for the first 6 weeks after the operation.  You will continue to find some specific movements, particularly twisting movements of the wrist (eg. opening a stiff door handle), painful for approximately 3 months after the operation.  Most people report that they have some tenderness around the site of their wound when they press on this for at least 6 months after the operation.  It is not unusual for people to feel that they have not fully recovered from the operation for up to 9 months.

Equally, the nerve itself can take some time to recover.  It is said that this is largely dependent on how long you have had your carpal tunnel syndrome for and how severely compressed the nerve has been during that time.  If the nerve has been severely compressed, then it may not recover completely. Nerves take a long time to improve if they have been severely compressed and it is often the case that you cannot really tell what your recovery will be from your carpal tunnel surgery for the first year.  Your surgeon will be able to give you more accurate guidance on what to expect based on your individual circumstances and your medical history.


  • Stiffness: Some people get stiffness after the operation. Try to keep the hand and wrist moving as instructed above.
  • Swelling: The hand swells after the operation, so keep it elevated.  Slight swelling can last a few months.
  • Infection: This is uncommon after the operation, but if the wound becomes red and swollen you may need antibiotics.
  • Scarring: The scar may be sore and sensitive for a few months.  Sometimes the area around it becomes numb.  Massaging with hand cream is very effective until it has settled down.
  • Bleeding/bruising: This may occur as in any operation and if you have problems you should seek advice.
  • Complex Regional Pain Syndrome: Some people complain of marked pain, sensitivity and stiffness after hand surgery.  This needs treatment with painkillers and physiotherapy.
  • Nerve damage: There is a possibility of damage to the nerves in the operation but this is rare.
  • Recurrence: This is uncommon but is known to occur.

Post-op exercises

After having surgery for Carpal Tunnel Syndrome (CTS), it's important to keep your fingers mobile. In this video, Dr Jon Williams demonstrates some exercises we recommend you do to help your recovery.

3. Useful websites