Carpal tunnel syndrome happens when the median nerve is compressed where it passes through the wrist. It causes numbness, tingling and pain in the thumb, index and middle fingers, usually worse at night. Mild cases often settle with a night splint. Where symptoms persist or the nerve is under sustained pressure, a short operation to release the tunnel is highly effective. It takes about 20 minutes as a day procedure, the dressing comes off after four to five days, and most people are driving and back at office work by then.
What is carpal tunnel syndrome?
At the junction between the forearm and the palm, nine flexor tendons and the median nerve pass through a tunnel formed by the carpal bones on three sides and a tough fibrous band, the transverse carpal ligament, across the front.
The tunnel does not stretch. If the pressure inside it rises, the median nerve is the structure that suffers, because nerves tolerate compression poorly compared with tendon. Raised pressure interferes first with the nerve's blood supply and its ability to conduct signals, which is why early symptoms come and go. Left long enough, the nerve fibres themselves are affected, and recovery after that point is slower and less complete.
That distinction matters clinically. Early carpal tunnel syndrome is a pressure problem and is largely reversible. Late carpal tunnel syndrome is a nerve damage problem, and while surgery reliably stops it getting worse, some numbness or weakness may persist.
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Dr Paul van Minnen
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Symptoms
The median nerve supplies sensation to the thumb, index finger, middle finger and half the ring finger, and powers some of the muscles at the base of the thumb. Symptoms follow that distribution.
Most people describe:
- Numbness or tingling in the thumb, index and middle fingers
- Symptoms that wake them at night, often relieved by shaking or hanging the hand out of bed
- Pain in the palm that can radiate up the forearm, occasionally as far as the shoulder
- Clumsiness with small objects, dropping things, difficulty with buttons or picking up coins
- In more advanced cases, visible wasting of the muscle bulk at the base of the thumb, and weakness of thumb pinch
The little finger is not supplied by the median nerve. Numbness confined to the little finger points somewhere else, usually the ulnar nerve at the elbow.
Symptoms are frequently worse in the morning, after driving, or after holding a phone or a book for a while. Many people have it in both hands, often worse in the dominant one.
Causes and risk factors
In most cases there is no single cause. The tunnel is simply narrow relative to its contents.
Contributing factors include:
- Anatomy. A constitutionally narrow carpal tunnel. This runs in families.
- Pregnancy. Fluid retention raises tunnel pressure. Pregnancy related carpal tunnel syndrome often resolves after delivery, so a splint and time are usually the right first step.
- Diabetes. Both raises the risk and makes nerves more vulnerable to compression.
- Thyroid disease, particularly hypothyroidism.
- Inflammatory arthritis, where synovial thickening around the flexor tendons takes up space in the tunnel.
- Previous wrist fracture, which can alter the shape of the tunnel.
- Sustained forceful or highly repetitive hand use, particularly with vibration. The relationship between ordinary keyboard work and carpal tunnel syndrome is far weaker than popularly assumed.
It is more common with increasing age and more common in women.
How it is diagnosed
Clinical examination
History and examination are usually enough. We are interested in the exact distribution of the numbness, whether it wakes you, how long it has been going on, whether it is getting worse, and whether there is any weakness or muscle wasting.
Examination includes sensory testing across the median nerve distribution, thumb abduction strength, inspection for thenar wasting, and provocative tests. Tinel's sign, tapping over the nerve at the wrist, and Phalen's test, holding the wrist flexed, are both useful but neither is definitive on its own.
Nerve conduction studies
In nearly all cases we confirm the diagnosis with a nerve conduction study before proceeding to surgery. It measures how well the median nerve conducts across the wrist and compares it with the ulnar nerve in the same hand.
The study serves three purposes. It confirms the compression is at the wrist and not the neck or elbow. It grades severity, which informs whether to try non-surgical treatment first. And it gives a documented baseline, which is genuinely useful if symptoms do not resolve as expected.
A nerve conduction study can be normal in early carpal tunnel syndrome. A normal study in someone with a clear clinical picture does not exclude the diagnosis, and we treat the patient rather than the report.
Ultrasound
Ultrasound is sometimes used to measure the cross sectional area of the nerve, or to look for a space occupying cause in the tunnel. It is not routine.
Non-surgical treatment
Night splinting
The single most useful non-surgical measure. A splint holds the wrist in neutral overnight, which is when tunnel pressure is highest, because most people sleep with the wrist flexed without knowing it.
Worn nightly, a splint gives meaningful relief in a substantial proportion of mild to moderate cases. Give it two to four weeks before judging whether it is working. It does not need to be worn during the day.
Hand therapy
Our hand therapists fit the splint properly, which matters more than the splint itself, and work on nerve gliding, tendon gliding and activity modification. Having therapy on site means this happens the same week rather than after another referral and another wait.
Corticosteroid injection
An injection into the carpal tunnel can settle symptoms and is a reasonable option where you want to avoid or delay surgery, or where the diagnosis is not entirely clear and a good response is informative.
The relief is often substantial but frequently temporary. A meaningful proportion of patients whose symptoms return go on to surgery. We would not repeat an injection more than twice in the same wrist.
What does not work
Wrist braces worn only during the day, oral anti-inflammatories, diuretics and vitamin B6 have all been studied and none of them changes the natural history. If you have been offered one of these as a definitive treatment, it is not.
Surgery
The operation divides the transverse carpal ligament, which immediately increases the volume of the tunnel and takes the pressure off the nerve. The ligament is not repaired. It heals with a small amount of scar tissue in a lengthened position, and hand function does not depend on it being intact. In some cases swollen tissue around the tendons also needs to be removed at the same time, which is called a tenosynovectomy.
Carpal tunnel release is one of the most reliable operations in hand surgery. It is performed as a day procedure, using sedation with a local anaesthetic, and takes approximately 20 minutes. The incision is closed with skin sutures, and a tape bandage covers the wound under a soft hand dressing.
Carpal tunnel release
Open release is the approach we use. A short incision in the palm, in line with the ring finger, typically 2 to 3 cm. The ligament is divided under direct vision.
Working under direct vision gives the most complete view of the nerve and the tunnel, and it lets us deal with anything else that needs attention at the same time, such as unusual anatomy, a space occupying lesion, or significant flexor tenosynovitis. It is also the approach used in revision surgery.
Endoscopic release is an alternative technique. It is not our default, and we are happy to go through the options and our reasoning with you at your consultation.
A short recovery
The dressing is small. The soft dressing comes off on day 4 or 5, leaving only a tape bandage on the skin, and most people are back to driving and office work at that point. Light manual work generally follows at two to four weeks and heavy work at four to six weeks.
Recovery, week by week
Indicative, and it varies. Your own timeline will depend on which hand was operated on and what you do. Night symptoms are usually the first thing to go and often settle within the first two weeks. Numbness that was constant before surgery takes longest and may not fully recover, which is the main argument against waiting too long.
Timeframe: What to expect
Day of surgery
Some or all of your fingers may feel numb or tingly for one to five days because of the local anaesthetic. You can move and use your thumb and fingers for light tasks before you leave hospital. Keep the hand elevated.
Days 1 to 5
Keep the soft dressing clean and dry. On day 4 or 5 you can take the soft dressing off your hand, but leave the tape bandage on the skin intact.
Days 4 to 5
Most people are back to driving and to office and light work at this point, once the soft dressing is off and you can grip the wheel comfortably.
Days 5 to 14
The tape bandage can get wet in the shower or when you wash your hand. Just dab it dry afterwards. If it comes off, use a bandaid to protect the sutures. Use the hand as tolerated and avoid heavy duties.
Two weeks
Your progress is reviewed by the doctor, hand therapist or practice nurse, and the skin sutures are removed at this visit. If needed, a new tape bandage goes on for another three to five days. It is common for some fingertips to still feel numb or tingly at this stage. How quickly that settles depends on how fast the median nerve recovers after being released.
Two to four weeks
Most people notice their symptoms improving within the first two weeks. Light manual work is generally manageable through this period. It is not abnormal for the area around the scar to stay tender or swollen for two, and sometimes six, weeks after surgery. Moisturising and gentle massage of the area help, and we will refer you to a hand therapist if that would assist your recovery.
Four to six weeks
Return to heavy work. A further follow up appointment if one is needed to monitor your progress. Most everyday activity is unrestricted by this point.
Up to 12 months
Where carpal tunnel syndrome was longstanding or severe, symptoms can take up to a year to reach their maximal improvement.
Risks and complications
Carpal tunnel surgery is routine and safe, and complications rarely occur. When they do they can include:
- Wound healing problems or infection. Uncommon, usually superficial, treated with antibiotics.
- Bleeding or bruising. Usually minor and settles on its own.
- Ongoing tenderness around the scar. Common in the early weeks, settles with time, moisturising and gentle massage.
- Slower than expected recovery. More likely where the nerve was severely or chronically compressed before surgery.
- Persistent numbness or weakness where nerve damage was already established before the operation.
- Nerve injury. Rare, and includes injury to a small palmar cutaneous branch, which causes a patch of altered sensation.
- Symptoms not improving, or coming back. Uncommon after a complete release. This may require another procedure in the future.
When to be seen sooner
Contact us, or see your GP, if you have:
- Constant rather than intermittent numbness
- Visible wasting of the muscle at the base of the thumb
- Weakness of thumb pinch, or dropping things
- Symptoms progressing quickly over weeks rather than months
- Symptoms following a wrist injury or fracture
- Severe pain not fitting the usual pattern
These suggest the nerve is under sustained pressure, where the argument for earlier surgery is stronger. If you have had surgery with us and have questions or concerns afterwards, phone the rooms any time on (08) 7127 0365.
Frequently asked questions
How long does carpal tunnel surgery take?
The operation itself takes approximately 20 minutes. Allow around half a day at the hospital for admission, the procedure and discharge. It is a day surgery procedure and you go home the same day.
Will I be awake?
Usually yes. Carpal tunnel release is done using sedation with a local anaesthetic, so you will not feel the operation. A general anaesthetic is available and is occasionally more appropriate.
How long will I have a bandage on?
The soft hand dressing comes off on day 4 or 5. Underneath it there is only a tape bandage on the skin, which can get wet in the shower from day 5 and stays until your two week review. If a new tape bandage is needed after the sutures come out, it goes on for another three to five days.
When can I drive?
Most people are driving again four to five days after surgery, once the soft dressing is off and you can grip the wheel and perform an emergency stop without hesitating. There is no legislation covering surgery and driving, so the test is whether you can control the car safely. Be aware that some insurers will not cover damage or liability if you have had recent surgery, were wearing a splint or cast while driving, or were taking pain medication that could affect your driving, so it is worth contacting your insurer first.
When can I go back to work?
Office and light work, usually four to five days. Light manual work, two to four weeks. Heavy work involving gripping, vibration or load through the palm, four to six weeks. We will give you a realistic estimate for your specific job before the operation, and a certificate.
Will the numbness go away completely?
Most people notice their symptoms improving within the first two weeks, and night symptoms often settle first. It is common for some fingertips to still feel numb or tingly at the two week mark, which depends on how quickly the median nerve recovers after being released. Where the carpal tunnel syndrome was longstanding or severe, symptoms can take up to a year to reach maximal improvement, and numbness that was constant before surgery may not fully recover. Surgery reliably prevents further deterioration.
Do you offer endoscopic carpal tunnel release?
Open release is the approach we use. Endoscopic release is an alternative technique, and we are happy to discuss the options with you at your consultation.
Do I need a nerve conduction study first?
In nearly all cases, yes. It confirms the compression is at the wrist rather than the neck or elbow, grades how severe it is, and gives us a documented baseline. It is a straightforward outpatient test.
Can I have both hands done at once?
Yes. We can release both hands in the one procedure, which suits people who want a single recovery and a single time away from work. The alternative is to space the two sides two to six weeks apart, which keeps one hand working throughout and is often easier if you live alone, care for children, or need to drive. We will talk through which suits your circumstances.
What does carpal tunnel surgery cost?
You will receive written informed financial consent setting out the surgeon, anaesthetist and hospital fees, your Medicare rebate and your health fund's contribution before anything is booked. Phone the rooms on (08) 7127 0365 for an estimate for your circumstances.
Do I need a referral?
A referral from your GP or another specialist means you can claim a Medicare rebate on the consultation. We can see you without one, but the rebate will not apply.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 1 September 2026