Carpal Tunnel Syndrome Surgery in Ankara, Turkey

Carpal tunnel syndrome is a nerve compression condition caused by pressure on the median nerve at the wrist level. The most common symptoms include numbness and tingling in the hand and fingers, as well as pain that often worsens at night. In advanced cases, muscle weakness may develop.

Common causes of carpal tunnel syndrome include repetitive hand movements, wrist trauma, pregnancy, and thyroid disorders. These factors increase pressure within the carpal tunnel in the wrist and disrupt the nerve’s normal function. Early precautions are especially important for people in high-risk groups.

Diagnosis is made through clinical examination and electromyography (EMG). Tinel’s and Phalen’s tests are frequently used during physical examination. EMG measures the nerve conduction speed to objectively determine the severity of compression.

Treatment options include wrist splinting, nonsteroidal anti-inflammatory medications, physical therapy, and corticosteroid injections. In more advanced cases, surgical decompression may be required to release the nerve. The treatment plan is individualized for each patient.

What Is Carpal Tunnel Syndrome Surgery?

Carpal tunnel syndrome surgery is a procedure in which the ligament compressing the median nerve at the wrist is surgically released to reduce pressure on the nerve. It is generally performed in patients whose symptoms do not improve with medication, splinting, or physical therapy, and who have progressive numbness, weakness, or pain. The surgery can be performed using an open or endoscopic technique. The goal is to prevent nerve damage and improve hand function. Early surgery reduces the risk of permanent damage.

What Are the Symptoms of Carpal Tunnel Syndrome?

Although symptoms vary from person to person, the story is usually quite similar. In the beginning, symptoms progress quietly and may appear only after days when you have used your hand a lot. Over time, they can become part of everyday life. As pressure on the nerve increases, the signals the nerve sends to the brain become “confused.” This confusion may present as pain, burning, or complete numbness. The thumb, index finger, and middle finger are typically affected the most.

The most common symptoms in more advanced stages include:

• Numbness that wakes you up at night
• Tingling at the fingertips
• A burning sensation in the palm
• Decreased hand dexterity
• A tendency to drop objects
• Weakness of the thumb muscles
• An “electric shock” sensation
• Pain radiating from the wrist up the arm

Night-time interruption of sleep is a particularly strong diagnostic clue. Patients often say, “Shaking my hand makes it better.” This is known as the “flick sign,” and the movement temporarily increases blood flow to the compressed nerve, providing short-lived relief. As the condition progresses, even this shaking may stop helping. Symptoms then begin to appear during the day as well, especially during activities that keep the wrist flexed—for example, holding a hair dryer, talking on the phone for a long time, or reading a book. A critical detail is that the little finger is usually not affected, because its sensation is supplied by a different nerve—this helps pinpoint the exact source of the problem.

Carpal Tunnel Anatomy and Causes: Why Does It Happen?

Understanding the internal anatomy of the hand helps explain why this condition develops. On the palm side of the wrist, there is a canal formed by wrist bones at the bottom and covered by a tough ligament on top. This is the “carpal tunnel.” You can think of it like a highway tunnel. Inside it pass nine tendons that move the fingers and the median nerve that supplies sensation to the hand. It is a rigid structure made of bone and a strong ligament and does not have room to expand.

Normally, these structures glide over one another within the tunnel. But if the tunnel’s volume is fixed while the contents swell, pressure rises. Imagine a crowded elevator with more and more people trying to squeeze in. When pressure increases, the most delicate structure—the nerve—gets compressed between tendons and bone. Nerve tissue is highly sensitive to pressure and reduced oxygen. When the tiny vessels that nourish the nerve are compressed, the nerve becomes “short of breath” and its conduction slows.

Risk factors that contribute to this increased pressure include:

• Genetic predisposition
• Repetitive wrist movements
• Computer use
• Pregnancy
• Diabetes
• Rheumatoid arthritis
• Thyroid disorders
• Obesity
• Wrist trauma
• Menopause

In pregnancy, fluid retention and swelling can increase pressure inside the tunnel and lead to temporary carpal tunnel syndrome, which often improves after delivery. It is also frequently seen as an occupational condition: people who use keyboards, assembly-line workers, musicians, and those who use vibrating tools are at increased risk. Sometimes, however, no clear cause is found—simply having a naturally narrow tunnel can be enough for the syndrome to develop.

Why Might a Plastic and Aesthetic Surgery Specialist Be Preferred?

From the outside, carpal tunnel surgery may look like a simple ligament-release procedure. In reality, it is much more nuanced. Plastic, Reconstructive and Aesthetic Surgery is fundamentally built on tissue repair and an aesthetic approach. Hand surgery is one of the core and most intensively trained areas within plastic surgery. For us, the hand is not only a moving organ—it is also a structure that feels, senses, and plays an important role in social interaction and appearance.

A plastic surgeon’s approach to carpal tunnel surgery is based on these principles:

• Maximum tissue preservation
• Microsurgical precision
• Aesthetic incision planning
• Scar management
• Functional restoration

Nerve tissue is extremely sensitive. A millimetric mistake can lead to irreversible sensory loss or painful neuromas. Plastic surgeons are trained to work under magnification (loupes or microscopes) and to protect delicate structures. While releasing the nerve, working without damaging nearby vessels, tendon sheaths, and—most importantly—the nerve itself is routine for us. In addition, the palm is one of the areas most prone to scarring and stiffness during healing. Hiding the incision in natural skin creases, using refined closure techniques, and preventing painful scar thickening are crucial. The goal is not only to relieve symptoms but also to ensure that, when you look at your hand, it is barely noticeable that you had surgery.

Which Methods Are Used for Diagnosis?

Diagnosis starts with what the patient describes: which fingers are numb, when pain occurs, and how symptoms affect daily life. However, we also need objective evidence and must measure how much the nerve has been affected. During physical examination, we use specific maneuvers such as the Phalen test (bringing the wrists into flexion) and the Tinel test (tapping over the nerve to see if tingling occurs). The most definitive and objective data typically comes from EMG.

EMG (electromyography) measures nerve conduction velocity. You can think of it like testing the integrity of an electrical cable. A mild electrical stimulus is applied, and we see how quickly and how strongly the signal reaches the target. If there is compression in the tunnel, conduction slows or the signal amplitude decreases.

EMG provides information such as:

• Whether nerve compression is present
• The severity of compression
• The type of nerve injury
• The risk of muscle wasting

Based on the EMG report, we classify the condition as mild, moderate, or severe. In mild stages, only sensory fibers show slowing; in severe cases, motor fibers that control muscles may also be affected. As plastic surgeons, we interpret EMG together with the clinical picture—not just the report alone, but also the patient’s hand function and how symptoms impact quality of life.

What Is the WALANT Technique and What Are Modern Surgical Approaches?

In the past, carpal tunnel surgery was often performed under general anesthesia, with hospital admission and uncomfortable tourniquets that stopped blood flow to the arm. As medical and plastic surgery techniques advanced, the process became much more comfortable for patients. Today, a widely accepted “gold standard” approach in many practices is the WALANT technique.

WALANT (Wide Awake Local Anesthesia No Tourniquet) means performing surgery while the patient is awake, under local anesthesia, without a tourniquet. This approach can greatly reduce surgical anxiety. The patient is fully awake and can talk with the surgical team or listen to music. Only the wrist area is numbed using a special solution. This solution typically includes both a local anesthetic and adrenaline, which temporarily constricts blood vessels. As a result, bleeding is minimal and the surgeon can work in a clear field.

Advantages of WALANT include:

• No need for hospital admission
• No general anesthesia risks
• No tourniquet pain
• Intraoperative motion check
• Same-day discharge
• Less tissue trauma
• Faster recovery

One of the most compelling aspects is that the success of the release can be confirmed immediately. After cutting the ligament compressing the nerve, the patient may be asked to move the fingers, allowing the surgeon to observe how structures glide more freely. The incision is typically a small “mini-incision” of about 2–3 cm, hidden within a natural crease of the palm—helping both recovery and cosmetic outcome.

What Is the Recovery Process Like After Surgery?

Many patients are surprised by how fast and relatively comfortable the recovery can be after carpal tunnel release. With WALANT, you can usually go home immediately after the procedure. There is no bulky cast; typically, only a dressing and a light bandage cover the incision.

Key steps during recovery include:

• Starting finger movements right away
• Keeping the hand elevated (at heart level)
• Keeping the wound dry
• Suture removal
• Scar massage
• Returning to normal activities
• Strengthening exercises

One essential rule: move your fingers early. Older advice to “not use the hand at all” is no longer recommended. Finger motion helps prevent adhesions and supports tendon gliding. Mild soreness can occur after anesthesia wears off, but it is usually controlled with simple painkillers. Sutures are typically removed around 12–14 days. After that, patients are often advised to massage the scar with silicone-based products to soften and fade it.

Office workers may resume keyboard use in about 3–4 days, while people who do heavy manual work often need 3–4 weeks to return at full capacity. Some patients may experience “pillar pain,” tenderness on the sides of the palm due to changes in load distribution after ligament release—this typically improves over time.