Carpal tunnel release surgery, especially minimally invasive ultrasound-guided carpal tunnel release offered by carpal tunnel specialist Dr. Johnny Nelson, is a great way to cure your carpal tunnel for good. The numbness, pain, tingling, waking up at night, difficulty with activities you love can all be treated with this procedure. It uses a simple “poke” incision, with NO anesthesia or IVs, NO painful tourniquet, taking 5-10 minutes, and both sides can be treated at the same time.

But is it normal to have pain after carpal tunnel release surgery?

Yes! But to fully answer that question you should understand what happens during carpal tunnel release surgery.

Carpal tunnel is caused by pressure at the wrist and base of the palm. Here an important nerve called the median nerve runs through a tight tunnel with several tendons.  Because there is limited space in this tunnel, any swelling leads to problems with the nerve in this narrow tunnel.

Carpal tunnel release surgery slightly “widens” the tunnel and gives the nerve and tendons more “room to breathe.”  To do this Dr. Nelson releases a ligament that is the “ceiling” of the tunnel.  This is very effective in relieving your carpal tunnel symptoms.  For example, patients who have the symptom of waking up at night will notice that this symptom is gone even on the night following the procedure.

However, it is normal to experience discomfort or pain at the base of the palm after carpal tunnel release surgery.  This is commonly called “pillar pain.”

There is no “one size fits all” healing after carpal tunnel release.  While Dr. Nelson does not restrict your activities after ultrasound-guided release, every patient is a little bit different.  While some patients go back to using heavy tools at 3 or 5 days after surgery, some patients even at 2 or 3 months may have some fatigue, soreness, and aching pain with heavier, repetitive activities.  However these cases are the exception rather than the rule, since the vast majority of patients will have this “pillar pain” for only 1 to 3 weeks after the procedure.

The other reason that pillar pain happens is that the muscles at the base of the thumb attach on to the ligament that is being released.  Because the thumb is very important in the use of your hand, many activities that cause the thumb muscles to move may lead to discomfort especially in the weeks following carpal tunnel release.

How painful is pillar pain?

Usually patients are so happy to be free of carpal tunnel symptoms that they are not very bothered by pillar pain. They can sleep a full night again! Even in cases of more severe pillar pain, patients are able to take care of themselves: They can dress themselves, use the bathroom independently, perform simple food preparation and chores around the house, etc.  The activities that they notice are limited are usually heavier activities (using heavy tools, opening a very tight bottle cap, wringing out a dish rag) or repetitive activities (brushing hair, cutting fabric).

To understand the healing process, it is helpful to think of it in terms of “hardening”.  This is the name given to the healing process after carpal tunnel release.  As mentioned, carpal tunnel release involves dividing a ligament, over time other tissues near the ligament “pick up the slack” and perform the duties of the old ligament, however it takes time for the new tissue to harden and reorient the tissue fibers to perform this activity well.

Are you or someone you love suffering from effects of carpal tunnel syndrome?  Call 919-872-5296 today to make a visit with Dr. Johnny T. Nelson, the North Carolina Carpal Tunnel Specialist, to see if you are a candidate for ultra minimally invasive carpal tunnel release with real-time ultrasound guidance!

Dr. Nelson Selected to Serve on the Executive Committee of the MSK Ultrasound Forum in Toronto, Ontario this October.

The forum will feature discussion and hands-on teaching by many thought leaders in the field of musculoskeletal ultrasound, including Dr. Nelson. His involvement reflects Dr. Nelson’s commitment to educating other surgeons on how to use ultrasound to bring the highest quality care to patients. In 2022, Dr. Nelson became the first and remains the only orthopaedic surgeon in the RDU area to offer ultrasound-guided carpal tunnel release, and in 2023 performed the first ultrasound-guided trigger finger release in the RDU area. He remains the only shoulder specialist in the RDU area to perform in-office complete real-time ultrasound examinations of the shoulder to help patients avoid costly MRI studies.

For more information on the ultrasound forum, you can find it here.

What are the advantages of ultrasound-guided carpal tunnel release?

Dr. Johnny T. Nelson offers ultra–minimally invasive carpal tunnel release under ultrasound guidance.  He is the first orthopedic surgeon in the Raleigh Durham area to perform this procedure, one of only two physicians in the state of North Carolina, and remains the only orthopedic surgeon offering this new technology for patients in the Raleigh-Durham area.

But what exactly is this procedure, and why is it better?

All carpal tunnel releases, no matter how they are performed, work by releasing pressure off of an important nerve at the level of the wrist, called the median nerve.

Carpal tunnel syndrome is very common, approximately 1 out of every 20 Americans suffers from this condition. That is A LOT of people.  It causes numbness, tingling, pain, especially in the thumb, pointer finger, and middle finger, it is often worse at night.  Patients often have to change what they are doing, or shake their hands out to make their symptoms better.

Unfortunately, many of these patients are reluctant to proceed with carpal tunnel release, even though this procedure would very likely cure their symptoms, help them to sleep a full night’s sleep, and continue to stay active and independent.  There are many reasons why they remain reluctant, but the fear of surgery, either the pain or anxiety of the surgical procedure, or the fear of prolonged healing and pain after the procedure, are most likely the main reasons. Economic concerns are another reason. 

Ultrasound guided carpal tunnel release helps to address these concerns.

This procedure can be done with local only anesthesia, meaning that Dr. Johnny Nelson can perform this without resorting to heavy medications, general anesthesia (for example, a sleeping tube down the patient’s throat), or expensive nerve blocks.  This is not only usually less expensive for the patient, but also is a great option for patients with other medical issues that make anesthesia difficult.

Ultrasound-guided carpal tunnel release also is performed without a tourniquet.  A tourniquet is a inflatable band that squeezes the arm being operated on so that the surgeon can see.  Because Dr. Nelson uses ultrasound guidance, a tourniquet is unnecessary.

Finally, this procedure is done through a very tiny poke incision.  Ultrasound-guided carpal tunnel release is the most precise way of releasing the pressure on your nerve without cutting and harming structures that are not involved with causing the carpal tunnel syndrome.  This tiny poke incision, its very small size and location slightly on the forearm, especially placed to avoid incisions on the palm that are more likely to be sensitive and interfere with activities after surgery.  As a result, many patients who have ultrasound-guided carpal tunnel release can return to their activities right away, certainly within 5 days of their procedure. No splint is necessary after surgery.

Do you have carpal tunnel syndrome?  Does anyone you know or love have carpal tunnel syndrome?  If so, call 919-872-5296 to schedule a visit with Dr. Johnny T. Nelson, MD for a consultation. 

To learn more about ultra-minimally invasive carpal tunnel release, visit Sonexhealth.com.

Johnny Nelson is a fellowship-trained shoulder & hand doctor practicing in association with the Bone & Joint Surgery Clinic in Raleigh, North Carolina.