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In those patients who do not gain relief from these non-surgical measures it may be necessary to perform surgery. The site of the operation is made pain-free by local anesthesia injected either into the wrist and hand or higher up in the arm. This may be done by your orthopaedic surgeon or an anesthesia doctor. The surgery itself is called a "release" - cutting the ligament that forms the roof of the carpal tunnel to relieve the pressure on the median nerve. The surgery is usually performed in an outpatient facility and you are generally not required to stay over night. Your doctor can explain to you the likelihood of non-surgical or surgical treatment based on your own individual circumstances.

What causes it?
Anything that causes swelling, thickening or irritation of the synovial membranes around the tendons in the carpal tunnel can result in pressure on the median nerve.

Some common causes and associated conditions are:

• repetitive and forceful grasping with the hands
• repetitive bending of the wrist
• broken or dislocated bones in the wrist which produce swelling
• arthritis, especially the rheumatoid type
• thyroid gland imbalance
• sugar diabetes
• hormonal changes associated with menopause
• pregnancy
• Although any of the above may be present, most cases have no known cause.

After surgery
After surgery, your symptoms may be relieved immediately or in a short period of time. Tenderness at the incision site may persist until healing is complete. Numbness may remain for a period of time, particularly in older persons or in more severe cases. It may be several weeks before you can return to your normal level of physical activities; for some, it will be several months. You will probably be given hand exercises to do to rebuild circulation, muscle strength and joint flexibility in your hand and wrist.

Your orthopaedist is a medical doctor with extensive training in the diagnosis and nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves. This brochure has been prepared by the American Academy of Orthopaedic Surgeons and is intended to contain current information on the subject from recognized authorities. However, it does not represent official policy of the Academy and its text should not be construed as excluding other acceptable viewpoints.

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