Carpal Tunnel Release
Carpal tunnel syndrome (CTS) happens when the median nerve is compressed as it passes through a narrow tunnel at the wrist, causing numbness, tingling, pain, and sometimes weakness in the hand.
Dr Oscar Brumby-Rendell is an upper limb orthopaedic surgeon in Adelaide and is highly skilled in performing carpal tunnel release procedures, utilising advanced techniques to provide effective relief.
Understanding Carpal Tunnel Syndrome
Symptoms typically develop gradually and can be worse at night or with repetitive wrist activities; factors such as pregnancy, diabetes, thyroid disease, arthritis, prior wrist injury, or a congenitally small tunnel can increase risk.
When conservative care fails or when there is progressive muscle weakness, surgical release of the transverse carpal ligament is often recommended to relieve pressure on the nerve and improve hand function.
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Diagnosis of Carpal Tunnel Syndrome
Diagnosis combines a careful history and physical exam (including Phalen’s and Tinel’s tests) with confirmatory tests when needed; most commonly nerve conduction studies and electromyography (EMG).
Imaging such as wrist ultrasound or MRI is sometimes used to rule out other causes or to visualise anatomy before surgery, particularly in complicated or recurrent cases. Early diagnosis and appropriate staging help guide whether conservative care, steroid injection, or surgical release is the best next step.
Non-Surgical Treatments
- Resting the affected hand - Short, regular rest breaks and temporary task modification reduce repetitive pressure on the median nerve and allow inflammation to settle. Total inactivity isn’t usually needed, targeted changes in how you use the hand are more practical and effective.
- Applying ice packs - Applying an ice pack to the wrist after activity can reduce local swelling and ease pain during flare-ups. Use ice for 10–15 minutes at a time with a cloth barrier to protect the skin.
- Physiotherapy (including nerve- and tendon-gliding exercises) - A hand therapist can teach nerve-gliding and tendon-gliding exercises plus ergonomic advice to improve nerve mobility and reduce symptoms.
- Corticosteroid injections - A steroid injection into the carpal tunnel often produces rapid symptom relief and can be useful for short-term control or diagnostic purposes.
- Addressing other medical conditions - Optimising underlying conditions such as diabetes, thyroid disease, or inflammatory arthritis can reduce nerve irritation and improve overall outcomes. Your GP may investigate and manage these contributors alongside local wrist treatments.
- Ceasing pain-inducing activities & ergonomic changes - Stopping or modifying tasks that provoke symptoms and improving workstation ergonomics reduces ongoing tunnel pressure and symptom recurrence.
- Wrist brace or splint - A neutral wrist splint, especially worn at night, prevents extreme wrist positions that raise tunnel pressure and commonly relieves nocturnal numbness.
- Diuretics and other medications - Diuretics have limited and inconsistent evidence for CTS and are not routinely recommended; any drug should be considered only after clinical review of potential causes.
Surgical Treatments for Carpal Tunnel Release
Surgery for carpal tunnel syndrome is considered when conservative treatments, such as splinting, medication, and physiotherapy, fail to provide relief. If symptoms persist or worsen despite these non-surgical measures, carpal tunnel release surgery may be recommended.
Carpal tunnel release surgery involves a procedure designed to alleviate pressure on the median nerve, which is compressed by the transverse carpal ligament. Dr Brumby-Rendell makes an incision in the wrist to access the carpal tunnel. The primary goal is to cut the transverse carpal ligament, which is the structure causing compression of the median nerve. By cutting this ligament, the pressure on the median nerve is relieved, which helps to reduce symptoms such as pain, numbness, and weakness in the hand and fingers.
Carpal tunnel release surgery has a high success rate, with most patients experiencing significant relief from symptoms. The procedure is typically performed on an outpatient basis, and many patients regain their normal function and improve their quality of life post-surgery.
Types of Carpal Tunnel Surgery
There are two main surgical approaches: endoscopic (keyhole) release and traditional open release. Both aim to cut the transverse carpal ligament but differ in incision size, visualization method, and recovery profile.
The best option depends on the anatomy of your wrist, prior surgery, surgeon experience, and the patient’s recovery expectations.
- Keyhole / Endoscopic surgery: Smaller incisions and use of a camera; can mean less initial pain and quicker return to light activities for some patients.
- Open carpal tunnel release: A slightly larger incision allowing direct visualization of the ligament; widely used and effective, especially if anatomy is complex or there is a prior scar.
Comparison: Studies show both methods relieve symptoms effectively; endoscopic may offer faster early recovery in some patients but requires specific surgeon experience. The choice should be individualized.
Choosing the right type of carpal tunnel release surgery will depend on your specific situation and needs. Dr Oscar Brumby-Rendell will evaluate individual factors, such as the severity of the condition and patient preferences, to recommend the most suitable surgical option for each patient.
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Post-Surgical Care and Recovery
Immediate Post-Operative Care
After surgery your wrist is bandaged and your hand elevated to limit swelling; finger movement is encouraged immediately to prevent stiffness.
Pain is usually manageable with oral analgesics, and most patients go home the same day.
- Keep the dressing clean and dry until your follow-up visit.
- Move fingers frequently to reduce stiffness and swelling.
- Report signs of infection or worsening pain to your surgeon promptly.
Typical Recovery Timeline
Early improvement in numbness and pain is common, but full recovery of strength and fine coordination can take weeks to months, especially if the nerve was severely compressed before surgery.
Many people return to desk work within a few days to a few weeks; jobs requiring heavy grip or forceful hand use may require several weeks longer or graded return.
- Light activities and desk work may resume within days to weeks, depending on comfort.
- Driving can usually resume once you can grip and brake safely and you are off narcotic pain medication. Check with Dr Oscar Brumby-Rendell when you can start driving.
- Heavy manual tasks often need protection and progressive strengthening for 6–12 weeks.
Physical Therapy and Exercises
A focused rehabilitation program helps restore range of motion, desensitise the scar, and rebuild grip strength. Hand therapists teach scar massage, nerve-gliding exercises, and progressive strengthening that are matched to each stage of healing.
- Scar mobilisation and tendon/nerve gliding promote smoother recovery.
- Gradual strengthening helps return function without overloading the healing tissues.
Avoiding Hand Stress & Returning to Normal Activities
Protect the wrist from heavy lifting, forceful gripping, and repetitive vibration for the recommended period; return to sport or heavy work only after guided strengthening and surgeon clearance. Long-term activity modifications or ergonomic changes at work can prevent recurrence.
- Use ergonomic tools and frequent breaks when returning to repetitive jobs.
- Consider workplace adjustments or wrist splints during flare-ups.
- Follow progressive return-to-work guidance, not a fixed calendar.
Frequently Asked Questions
Yes! Corticosteroid injections into the carpal tunnel often give temporary symptom relief and are useful for diagnosis or short-term management (for example during pregnancy or while awaiting surgery).
However, relief may be temporary and repeated injections have limits; definitive long-term relief is more reliably achieved with surgery when severe nerve compression is present.
Why Choose Dr Oscar Brumby-Rendell?
Dr Oscar Brumby-Rendell is a specialist orthopaedic surgeon with focused expertise in hand and wrist conditions, offering up-to-date surgical techniques and personalised rehabilitation plans. At the Adelaide Shoulder & Upper Limb Clinic he provides thorough diagnostic assessment, evidence-based care, and coordinated follow-up with experienced hand therapists to maximise recovery and return to daily life.
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Specialist training in hand and wrist surgery with experience in both open and endoscopic carpal tunnel techniques.
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Individualised care pathway from diagnosis through to rehabilitation and workplace return.
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Focus on patient education, shared decision-making, and minimising downtime while achieving durable results.
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