Complications of Carpal Tunnel Surgery

Surgery is a common treatment for carpal tunnel syndrome.  Surgery can either be performed as a traditional open surgery or as an endoscopic minimally invasive surgery.  There are possible complications of surgery, and while the chance of these complications is small, any the patient having carpal tunnel surgery should understand these possible risks.

1
Incision/Pillar Pain

wrist pain
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Pain in the area of the incision is especially common after a traditional open surgery, rather than endoscopic carpal tunnel release.  There a two types of pain that occur in the palm of the hand after carpal tunnel surgery: incisional pain and pillar pain.

Incisional pain occurs directly at the site of the incision.  Pain directly at the incision is typically only present for days or weeks after the surgery.  Protecting the incision can help alleviate pain, and it's important to avoid lifting or gripping for several weeks after carpal tunnel surgery.

Pillar pain is the pain experienced to the sides of the incision in the thicker parts of the palm, called the thenar and hypothenar eminence.  Pain in these regions are where the attachments of the transverse ligament to the carpal bones (forming the carpal tunnel) are located.  In addition, the muscles of the palm of the hand are located here.  Pillar pain is the more common and troublesome complication of carpal tunnel surgery, and may take several months to resolve.

Treatments of pillar pain may include rest, massage, and hand therapy.  Additional surgery is generally ineffective for treatment of pillar pain,

2
Persistent Numbness/Tingling

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There are two reasons why people have persistent symptoms of numbness and tingling after carpal tunnel surgery.  One reason is the transverse carpal ligament is not completely released.  The second reason is if there is long-standing compression to the median nerve in the carpal tunnel.

Incomplete release of the transverse carpal ligament can lead to persistent compression on the median nerve, and therefore persistent symptoms.  This complication is more common with endoscopic carpal tunnel surgery.

Some people who have long-standing carpal tunnel syndrome may have persistent numbness and tingling even after carpal tunnel release surgery.  This is thought to be the result of long-standing compression and therefore more significant nerve damage.  In fact, in some people have nerve damage so severe that sensation is never restored to normal.  An EMG study (nerve test) can help give an indication of the severity of the nerve compression prior to surgery.

3
Infection

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Infection is an uncommon complication, but still a possibility after both open and endoscopic carpal tunnel surgery.  It is important to follow your surgeon's instructions carefully to ensure that you're taking proper care of the incision area.  There are steps he can take to help prevent the possibility of infection.  Of particular note, while some surgeons may choose to use antibiotics, they are not routinely needed for carpal tunnel surgery.  If ​an infection does occur, antibiotics can be an effective treatment, and sometimes additional surgery is needed to clean out the infection from the surgical wound.

4
Nerve Injury

scalpel hand surgery
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Injury to the median nerve, or its branches, is uncommon during carpal tunnel surgery, but certainly a risk.  Chance of nerve injury is slightly higher with endoscopic carpal tunnel surgery.  The typical injury occurs to a small branch of the nerve that either control the muscles of the thumb (the motor branch) or sensation to the palm of the hand (the palmar cutaneous branch). 

5
Recurrent Carpal Tunnel Syndrome

hand pain
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It is possible of having recurrent symptoms after carpal tunnel surgery.  The likelihood of this complication is estimated to be about 10-15%.  Unfortunately, even if this problem is addressed with another surgical procedure, the results of a second surgery tend to be not as favorable as the results of an initial surgery.

Bottom Line: A Safe Surgery, But Not Without Risk

Carpal tunnel surgery is very safe, and very effective at treatment of carpal tunnel syndrome. However, as with any invasive treatment, there are risks of surgery. Even though these risks are small, patients should understand the possible complications of this treatment.

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