Endoscopic Carpal Tunnel Surgery (ECTS) is a minimally invasive procedure that relieves pressure on the median nerve by dividing the transverse carpal ligament through one or two small incisions. This approach typically allows for a quicker initial recovery compared to traditional open surgery. Understanding the expected stages of recovery is important for navigating the weeks and months following your operation and ensuring the best possible outcome.
The Immediate Post-Operative Period
Immediately following the procedure, your wrist and hand will be wrapped in a bulky dressing or splint. This dressing is designed to protect the small incision and minimize motion at the surgical site. The dressing leaves your fingers free, and you should move them gently right away to prevent stiffness and promote circulation. Temporary numbness or tingling from the local anesthetic is common and should wear off within a few hours, though residual numbness may persist for up to 48 hours.
Managing swelling is a primary focus during the first one to two days. Keep your hand elevated above the level of your heart as much as possible to reduce fluid accumulation and decrease discomfort. Mild to moderate pain is normal and should be manageable with prescribed pain medication. If the pain is severe or rapidly worsening, contact your surgeon immediately.
Begin gentle, active range-of-motion exercises for your fingers and thumb within the first 48 hours to maintain flexibility. These movements help keep the tendons gliding smoothly and prevent long-term stiffness. Keep the entire surgical dressing clean and completely dry until your first follow-up appointment.
Navigating the First Two Weeks of Recovery
The initial two-week period transitions from protective rest to the careful reintroduction of light daily activities. Your first post-operative appointment is usually scheduled between 10 to 14 days. This is when external sutures are typically removed or the incision is checked. The bulky dressing is then replaced with a small bandage, and your surgeon will provide specific instructions on gently washing the area.
Normal bruising around the wrist or palm is common. Avoid submerging the hand in water, such as in a bath or swimming pool, until the incision is fully healed and closed. This prevents infection and allows for optimal skin healing.
Activity restrictions protect the healing transverse carpal ligament. For the first two weeks, do not lift anything heavier than one to two pounds. This restriction prevents excessive pressure that could lead to complications. Repetitive gripping, pinching, or grasping movements must also be avoided.
Resuming driving depends on your pain level and whether you are taking narcotic pain medication, which is discouraged while operating a vehicle. Many patients drive within a few days to two weeks if they can comfortably grip the steering wheel. Light office work, such as typing, may be resumed within ten days, but take frequent breaks and stop if it causes pain.
Physical Therapy and Return to Full Activity
Once the incision heals, the focus shifts to regaining full range of motion and strength, often through prescribed exercises or physical therapy. Stiffness is a common side effect, so gentle mobility exercises for the fingers and wrist are introduced early to reduce the risk of long-term contractures. A physical therapist may teach median nerve gliding exercises, which help the nerve move freely and prevent scar tissue from adhering to it.
Strengthening exercises are gradually introduced around four weeks post-surgery, using light resistance tools like therapy putty or small weights. The goal is to rebuild grip strength weakened by the surgery or prior nerve compression. Returning to vigorous activities takes longer, as the healed ligament needs time to mature and withstand significant force.
Most patients can return to heavy manual labor, intense gripping, or vigorous sports requiring strong wrist function around six weeks post-surgery, although some surgeons recommend waiting longer. The timeline for the ultimate resolution of pre-operative symptoms, such as numbness and tingling, varies based on the severity and duration of prior nerve compression. While nighttime numbness often improves immediately, the full recovery of sensation and strength can take several months, and in severe cases, up to a year.
Recognizing Potential Complications
The healing process is usually straightforward, but be aware of signs that indicate a complication requiring immediate medical attention. Report any sudden and severe increase in pain that is not relieved by elevation, rest, or prescribed medication to your surgeon’s office. Uncontrolled pain can indicate a developing issue.
Signs of infection include a fever of 100.4 degrees Fahrenheit or higher, increased warmth, or spreading redness around the incision. Also watch for excessive or foul-smelling drainage. A small amount of clear or pinkish drainage is common initially, but if the dressing becomes continuously soaked with blood or pus, seek urgent evaluation.
Monitor the sensation and movement in your fingers after the local anesthetic wears off. If you experience a complete loss of movement, or if pre-operative numbness and tingling suddenly worsen and persist beyond 48 hours, contact your surgical team immediately. Early detection of these symptoms allows for the quickest intervention and best chance for a full recovery.