When patients undergo carpal tunnel release surgery the doctor makes an incision on the palm of your hand. A carpal tunnel surgery scar will always result after having this operation. 

But the incision can be large or small. This, in turn, determines the size of your scar. And it's the type of operative procedure you have which determines the size of the incision and the size of your resulting scar. 

If everything goes right, this permanent reminder of your operation will be the only thing left of this painful or numbing condition. But if things don't go right, any number of issues may also leave a permanent reminder.

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It's important to know that scarring happens both above and below the skin. Scarring below the skin can cause complications. The worst of these are usually persistent pain and limited hand mobility (see below).

But the majority of patients are concerned with scarring above the skin. In other words, usually the cosmetic result is most important. They want to know what it will look like, how it will feel, and how it will change their hand’s appearance. These are legitimate concerns. 

The answers to these questions largely depend on the type of surgery you have. This is discussed next.

After carpal tunnel surgery, scar size will mostly be determined by the type of hand surgery you have. You will have one of two types of operative procedures:

• Open release carpal tunnel release surgery
  
  
• Endoscopic carpal tunnel release surgery

The goal of both procedures is to cut the transverse carpal ligament in your wrist joint. Doing so lets the wrist bones snap apart. This provides more room for the median nerve so it's no longer crushed by the tissues around it. That nerve crushing is what causes all of the symptoms of carpal tunnel syndrome.

Most doctors use open release surgery to relieve carpal tunnel syndrome. Generally they need to relieve the most severe carpal tunnel symptoms like hand or finger pain, numbness, tingling and weakness. 

All patients who have this surgery will have a hand scar. Once again, the scar you see on your skin surface is just one scar resulting from carpal tunnel surgery. Scar formation also happens below your skin. 

Actually, the scar deep in your wrist tissues is much larger, more spread out, and therefore more medically significant. This is the scar that determines how long your recovery will take. In contrast, the scar above the skin is only a cosmetic issue.

There are 4 main consequences of the carpal tunnel surgery scar. These are:

• Pain and tenderness
• Diminished hand mobility
• The resulting cosmetic scar
• The remaining financial scar

After carpal tunnel surgery, scar tenderness and paresthesia (abnormal sensation on the skin) are completely normal. As the outside scar tissue forms in 2-5 weeks after surgery, you may have flare-ups of your symptoms. Much of this is a result of post-surgical adhesions under the skin.

Generally, the painful feelings are sudden and brief. They feel like electricity running through your hand and into your fingers. In fact, for a time, you almost always feel this pain when grasping something.

This is different from any pillar pain you might feel. That's actually a complication causing pain or tenderness adjacent to the visible surface scar.

Once the doctor stitches your incision closed to complete your carpal tunnel surgery, scar formation begins in earnest. Cutting the transverse carpal ligament requires cutting and displacing many more tissues inside your wrist.

Consequently, this often creates problems with your hand’s function. Actually, there is almost always a direct link between surgery for carpal tunnel and some loss of grip strength.

Surgery causes a loss of structural integrity inside the wrist joint. As a result, hand function may be diminished right after surgery and even weeks or months later. That’s because of the scarring below the skin. When this happens, tissues bind together with adhesions. For this reason, wrist and hand movements often become restricted.

Furthermore, as the scar tissue progresses around the flexor tendons, they also bind up. That prevents them from smoothly gliding past each other inside the wrist joint. Consequently, pain and loss of mobility (or range of motion) can follow. 

Sometimes patients need a second carpal tunnel surgery. That's because scar tissue can build up so much that it causes problems deep inside. Hence the name revision carpal tunnel release surgery for the procedure when this happens. It's essentially the same surgery performed all over again.

Many people feel the need to apologize for their carpal tunnel surgery scar. This highlights the importance of how we feel about our personal appearance. 

In fact, ask any surgeon and they'll tell you that patients considering hand surgery ask one question most often. That is, "Will my scar be big?" Women in particular tend to ask about this even before asking how much pain they'll experience (which is the most common question among men).

Indeed, for many, physical appearance is important to their self-esteem. For now, we won’t discuss whether or not this is healthy, just that it’s fact. For such patients who believe their hands are their calling cards, having a carpal tunnel surgery scar is an important matter.

I can certainly understand that "an ugly scar" affects everybody differently. So don’t be ashamed about being concerned over it. If that’s a main reason to shy away from surgery, so be it. Besides, you have other non-surgical options that work just as well as surgery. And none of them leave a scar.

A carpal tunnel surgery scar is not just a surface reminder of your operation. There's also a lot of scar tissue below the skin - inside your wrist joint. In fact, that scar is far more extensive than the one on your skin. Moreover, it’s a primary cause of complications as well as emotional and financial problems.