Open Carpal Tunnel Release

Indications

  • Carpal tunnel syndrome failing splinting or steroid injection
  • Thenar wasting or constant numbness
  • Acute carpal tunnel syndrome after trauma
  • Nerve conduction studies confirm the diagnosis and grade severity
  • Endoscopic release is an alternative with faster return to work but a small risk of nerve injury

Position

  • Supine, arm table, local anaesthetic with or without tourniquet (WALANT)
  • Hand supinated on a lead hand holder

Operative Steps

  1. Incision in line with the radial border of the ring finger, distal to the wrist crease
  2. Stop proximal to Kaplan cardinal line to protect the superficial palmar arch
  3. Divide palmar fascia and the transverse carpal ligament under vision
  4. Release the distal antebrachial fascia
  5. Protect the recurrent motor branch, usually radial and distal
  6. Close skin only
  7. Divide the ligament on its ulnar side to protect the median nerve and motor branch
  8. Inspect the floor of the canal for masses
  9. Neurolysis and flexor tenosynovectomy are not routinely needed

Postoperative Care

  • Early finger motion
  • Avoid heavy grip for a few weeks
  • Light dressing for 2 to 3 days
  • Sutures out at 10 to 14 days
  • Night symptoms usually settle within days, while numbness may take months to improve

Complications

  • Incomplete release
  • Pillar pain
  • Palmar cutaneous branch injury
  • Recurrent motor branch injury
  • Infection and painful scar
  • Complex regional pain syndrome
  • Persistent symptoms, check the diagnosis and the completeness of the release

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.