Mr Abhinav Gulihar is a highly experienced orthopaedic surgeon providing specialist care for patients in London and Kent. As a consultant with a focused interest in hand and wrist surgery, he treats a wide range of conditions, including carpal tunnel syndrome, tendon disorders, and complex wrist injuries such as distal radius fractures.
Carpal Tunnel Syndrome (CTS) is caused by compression of the median nerve at the wrist. It can lead to persistent numbness, tingling, burning pain, and weakness—often affecting sleep, grip, and everyday tasks such as driving, typing, or holding a phone. Treatment is individualised and typically begins with non-operative options. When these no longer provide lasting relief, surgery may be recommended to decompress the nerve.
Mr Gulihar offers expert assessment and modern surgical treatment for CTS, helping patients in London and Kent achieve reliable, long-term symptom improvement.
Understanding Carpal Tunnel Syndrome Surgery
The aim of CTS surgery is to relieve pressure on the median nerve by dividing the transverse carpal ligament, the band of tissue forming the roof of the carpal tunnel. Once released, the tunnel has more space and the nerve can recover.
Many patients notice rapid improvement in night symptoms. However, if the nerve has been compressed for a long time, recovery of sensation and strength may take longer, and in severe cases some symptoms may not fully reverse.
Non-Operative Management of Carpal Tunnel Syndrome
Non-operative treatment is often effective in early or moderate carpal tunnel syndrome and aims to reduce irritation of the median nerve, control symptoms, and delay or avoid surgery.
Activity Modification
Reducing activities that involve prolonged wrist bending, repetitive gripping, or forceful hand use can significantly improve symptoms. Ergonomic adjustments at work—particularly for keyboard and mouse use—are often helpful.
Wrist Splinting
Night splints hold the wrist in a neutral position, reducing pressure within the carpal tunnel. This is especially effective for patients with night-time symptoms or intermittent numbness.
Pain Relief and Anti-Inflammatory Medication
Simple painkillers or anti-inflammatory medication may help manage discomfort, particularly during flare-ups. These treatments do not address the underlying nerve compression but can improve symptom control.
Hand Therapy
A specialist hand therapist may provide:
- Nerve-gliding exercises
- Advice on posture and activity modification
- Splint fitting and optimisation
Therapy does not reverse CTS but can be beneficial in selected patients.
Corticosteroid Injections
Steroid injections into the carpal tunnel can reduce inflammation and relieve symptoms, sometimes for several months. They may be useful:
- In moderate CTS
- As a temporary measure
- As a diagnostic aid
Relief is often temporary, and repeated injections may become less effective over time.
When Surgery Is Considered
Surgery is usually recommended when:
- Symptoms persist despite appropriate non-operative treatment
- Numbness becomes constant
- Hand weakness or muscle wasting develops
- Nerve conduction studies show significant compression
Early surgery may be advised in severe cases to prevent permanent nerve damage.
Surgical Options for Carpal Tunnel Syndrome
Mr Gulihar performs both open carpal tunnel release and ultrasound-guided carpal tunnel release, tailoring the technique to your symptoms, anatomy, medical history, and work or sport demands.
Open Carpal Tunnel Release
Open release is the traditional and most established technique. A small incision is made in the palm, allowing the ligament to be directly visualised and carefully divided. This provides excellent visibility and is suitable for most patients, including complex cases.
Open surgery may be preferred when there are anatomical variations, scarring from previous surgery, recurrent CTS, or when the diagnosis is uncertain.
Ultrasound-Guided Carpal Tunnel Release (Minimally Invasive)
Ultrasound-guided carpal tunnel release uses real-time ultrasound imaging to visualise key structures—including the median nerve, surrounding tendons, blood vessels, and the transverse carpal ligament. A very small incision is typically made at the wrist or palm, and specialised instruments are used to release the ligament under ultrasound guidance.
This approach is designed to minimise soft tissue disruption and may allow faster early recovery in suitable patients. Mr Gulihar will advise whether this option is appropriate for you.
Comparison of Techniques
| Surgical Technique | Incision Size | Typical Early Recovery | Best Suited For |
| Open Release | 3-4 cm in the palm | Slightly longer, early scar tenderness | Complex/recurrent CTS, altered anatomy, need for direct visualisation |
| Ultrasound-Guided Release | Often <1 cm | Faster early comfort for some patients | Patients suitable for minimally invasive release and quicker return to light activities |
What to Expect from Surgery
The primary goal is relief of numbness, tingling, burning pain, and night-time symptoms. Many patients improve quickly, especially regarding sleep disturbance. Grip strength may take longer to return and commonly improves progressively over weeks to months.
Your outcome depends on factors such as:
- How long symptoms have been present
- Severity of nerve compression
- Any muscle wasting at the base of the thumb
- Diabetes, thyroid disease, inflammatory arthritis, or other contributing conditions
Mr Gulihar will explain what is realistic for your specific case.
Recovery After Carpal Tunnel Syndrome Surgery
Recovery varies between individuals and between techniques, but a typical timeline is:
First 1–2 Weeks
- Dressing/bandage in place
- Elevation helps reduce swelling
- Gentle finger movement encouraged immediately
- Avoid heavy lifting, forceful gripping, and repetitive wrist strain
2–6 Weeks
- Discomfort and swelling gradually settle
- Many patients return to desk work and light daily activity
- Hand therapy may be advised for stiffness, swelling, or scar sensitivity
6–12 Weeks
- Most patients resume normal activities, including heavier tasks as guided
- Strength continues to improve
3–6 Months
- Ongoing improvement in strength and sensation is common
In long-standing CTS, recovery can continue up to 12 months
Potential Complications and Risks (More Detailed)
Carpal tunnel release is a safe and commonly performed procedure, but all surgery carries potential risks. These are uncommon overall, but it is important to understand them.
General Surgical Risks
- Bleeding / Bruising / Haematoma: A small collection of blood can form under the skin causing swelling and pain; rarely it needs drainage.
- Infection: Usually minor and treatable with antibiotics; deeper infection is rare but may require further treatment.
- Delayed Wound Healing: More common in smokers, diabetics, and patients with vascular disease.
- Scarring: The scar can be thickened or sensitive. Some patients develop a tender scar that takes time and therapy to settle.
Nerve-Related Risks
- Persistent Numbness or Tingling: If the nerve was severely compressed for a long time, symptoms may improve slowly or not fully resolve.
- Nerve Irritation (Neurapraxia): Temporary increased tingling, “electric shock” sensations, or sensitivity during healing.
- Injury to the Median Nerve or Small Branches: Rare but important; can lead to sensory changes, weakness, or pain.
Pain and Functional Issues
- Pillar Pain: Aching or tenderness on either side of the incision at the base of the palm. This is relatively common early on and typically improves over weeks to months.
- Stiffness: Temporary stiffness of fingers or wrist can occur, especially if movement is avoided due to discomfort.
- Reduced Grip Strength Initially: Normal in the short term; strength usually returns gradually.
Procedure-Specific Risks
- Incomplete Release: Rarely, the ligament is not fully divided, leading to ongoing symptoms and possible need for revision surgery.
- Recurrence: True recurrence is uncommon, but symptoms can return, particularly if there are ongoing contributing factors (e.g., diabetes, inflammatory arthritis, repetitive strain).
- Tendon Injury: Very rare, but potential risk with any release procedure.
Less Common but Serious Complications
- Complex Regional Pain Syndrome (CRPS): A rare condition causing disproportionate pain, swelling, colour/temperature changes, and stiffness. Early recognition and treatment are crucial.
- Vascular Injury: Injury to blood vessels is rare but possible.
- Allergic Reaction: Rare reactions to dressings, antiseptic solutions, or local anaesthetic can occur.
Mr Gulihar will explain your individual risk profile, including factors that may increase risk, and how these risks are minimised.
Frequently Asked Questions (Expanded)
- How long does carpal tunnel surgery take?
The procedure is usually quick, often around 10–20 minutes, though appointment time is longer due to preparation and aftercare. - Is it done under local anaesthetic?
Most carpal tunnel releases are performed under local anaesthetic. This numbs the area so you are comfortable during the procedure. - Will I be awake during the operation?
Typically yes with local anaesthetic. If you are anxious, this can be discussed at consultation. - How soon will symptoms improve?
Night-time symptoms often improve quickly. Numbness and strength may take weeks to months, especially in severe or long-standing CTS. - What if I have constant numbness or muscle wasting?
Surgery can prevent further nerve damage and may improve symptoms, but recovery may be slower and sometimes incomplete if the nerve has been significantly affected. - When can I return to work?
Desk work may be possible within 1–2 weeks. Manual work often takes longer (commonly 4–8+ weeks), depending on pain, strength, and job demands. - When can I drive again?
Usually when you can comfortably grip the steering wheel and perform an emergency stop safely—often around 1–2 weeks, but it varies. - Will I need physiotherapy or hand therapy?
Not always, but hand therapy can help with stiffness, swelling control, scar sensitivity, and regaining function—especially in more symptomatic recoveries. - What activities should I avoid after surgery?
Avoid heavy lifting, forceful gripping, and repetitive wrist strain until advised it is safe to progress. - Can carpal tunnel come back after surgery?
Recurrence is uncommon, but symptoms can return, particularly if there are underlying causes (e.g., diabetes, inflammatory arthritis, ongoing repetitive strain). - What are the warning signs after surgery that I should contact the clinic?
Increasing redness, swelling, worsening pain, discharge from the wound, fever, severe swelling, or new/worsening numbness should be reported promptly. - Is ultrasound-guided release suitable for everyone?
Not always. Suitability depends on anatomy, severity, previous surgery, and clinical findings. Mr Gulihar will advise what is appropriate for your case. - What is the difference between ultrasound-guided and open release in recovery?
Many patients find minimally invasive approaches have less early wound tenderness and smaller scars, though long-term outcomes are generally excellent with either approach when appropriately selected.
What is the first step to arranging surgery?
Book a consultation with Mr Abhinav Gulihar for assessment, confirmation of diagnosis, and discussion of the best treatment option.
Book Your Appointment with Mr Abhinav Gulihar
If your symptoms are persistent, worsening, or affecting sleep and daily life, specialist assessment can help confirm the diagnosis and guide treatment. To book a consultation with Mr Abhinav Gulihar in London or Kent, please get in touch with the clinic.