The reason you get carpal tunnel syndrome in the first place is unknown. Many scientists insist it comes from overworked hands. But there's lots of data from people who don't overwork their hands but still get this condition.

However, we do know what happens when you get this awful disorder. At first, the flexor tendons inside your carpal tunnel space (in green in picture at the left) become inflamed. These are the tendons on the soft palm-side of your forearm. When they inflame, they swell up.

The problem arises when the tendons swell inside your carpal tunnel space. This area is jam-packed with tendons and blood vessels. But it also contains the median nerve, which causes all the problems. This is a main nerve of the hand that sends information to the brain about pain, touch, temperature, etc.  

As the tendons swell up inside the carpal tunnel space, they start to push on the median nerve. In time, with more and more swelling, the tendons eventually crush the median nerve. As the nerve is crushed, you get all of the symptoms of carpal tunnel syndrome. 

As the median nerve becomes crushed, it produces paresthesia, or abnormal sensations. These include feelings of pain, numbness, burning, pins & needles or weakness.

These feelings are distributed on the fingers and palm as shown in the illustration to the left. Note how only certain parts of the fingers and hand are affected by carpal tunnel syndrome.

When it starts out, carpal tunnel syndrome usually only appears while you're trying to sleep. As it progresses, symptoms seem to come and go during the day. Sometimes you feel shooting electric shocks in your hand. 

More severe symptoms truly interfere with your daily life. They include much more intense paresthesia (usually pain or numbness). They also include loss of dexterity, diminished grip strength and loss of temperature sensitivity.

OPEN Carpal Tunnel Release Surgery 

For this type of surgery you can have either local or general anesthesia. The actual surgical technique requires the doctor making a 2-3 inch long incision in your palm. Then the surgeon – with a clear view of the transverse carpal ligament – cuts it in half.

The advantage of this technique is that there is no doubt about where the ligament is or if it was completely cut. As you can see in the photo on the left, the 2-3 inch long incision essentially spreads your palm open so all vital structures can be seen. This is important because the doctor can easily avoid cutting or nicking other important structures like a nerve or blood vessel. Such safety measures reduce post-surgical complications.

The disadvantage of this technique is all about slower recovery: for carpal tunnel surgery using the open method, there’s much more trauma to the hand. The large incision interrupts more subcutaneous tissues like fascia and muscle. This means more post-surgical pain and longer recovery time. In most instances, it also means more lengthy hand rehabilitation.

ENDOSCOPIC Carpal Tunnel Release Surgery 

This operative procedure also uses either local or general anesthesia. With endoscopic surgery, the doctor makes either one or two small holes in your palm (instead of a long incision). Then a camera (endoscope) and scalpel are inserted into the hole or holes, as shown in the photo on the left. The surgeon then locates the transverse carpal ligament and cuts it in half.

The advantage of this technique is that making one or two small holes in the palm means much less trauma to your hand. That means much less post-surgical pain and less functional loss (like strength). This impacts how long it takes for complete recovery: for carpal tunnel surgery using endoscopy it's generally much faster and requires less hand rehabilitation.

But the disadvantage of this technique is the increased possibility of surgical error. Since the visual field is not as wide as with the open technique, there’s a greater chance the surgeon can accidentally cut or nick a nerve or blood vessel. This increases the probability of complications like loss of hand function and internal bleeding.

Make sure you elevate your hand as much as you can - even if just sitting in a chair. That means your hand must be above your heart level. Certainly sleep with an elevated hand, on a pillow, as in the photo on the left. Elevation reduces swelling and pain which will let you get some sleep.

Do not move around too much as more blood pumping into your wrist will just cause more pain. And if you accidentally bump your hand while moving around, you may rip the stitches. Also, do not bathe for 2-3 days or get the bandages wet. If they get wet, they will need to be replaced. Rewrapping  your hand will be painful.

The idea is to give your hand a few days of rest to naturally heal from the surgical trauma. Successful recovery for carpal tunnel surgery mainly means “baby your hand!”

After several days at home you'll feel a lot better. Pain will be at a minimum. Some pain may persist if you had open carpal tunnel release surgery due to the more extensive surgical trauma. But that too will subside in a matter of days. By this time, over-the-counter painkillers will work just fine.

Low level physical therapy should also begin after few days. This is necessary to avoid the formation of adhesions. They can cause a lot of pain and restrict movement. Gentle finger stretches, as pictured on the left, keep adhesions from forming. 

By about 2 weeks you will follow up with a return visit to your doctor's office to remove the stitches. This isn't a painful process but patients describe it as itchy and uncomfortable. 

You'll be given a wrist brace to wear which should be worm 24/7 for the next month.

Within approximately 2 weeks you will begin a comprehensive hand rehabilitation program. This is important because clinical research shows patients who demonstrate the best long term recovery for carpal tunnel surgery underwent extensive physical therapy and rehabilitation. 

The therapist will give you instructions about how to perform strength and mobility exercises at home. They will get more and more intense as the weeks pass. Under normal conditions, and with no complications, you will restore you hand's strength and mobility within 3 months.