Patients considering a hand operation often want to know about the level of pain after carpal tunnel surgery. In fact, I believe this is the most common question I get about carpal tunnel release surgery. 

I always reply, “Yes, there's pain, but there are different kinds of pain.”  

Specifically, there are 2 types of pain that usually result from surgery. Both are normal after having carpal tunnel release surgery. Therefore, any pain that feels different from these 2 types may indicate something else is wrong.

Immediate pain after carpal tunnel surgery is perfectly normal - and expected. The pain's intensity usually is related to the type of surgery you have:

• Pain normally is more intense with the open release type of surgery.
• The endoscopic release type of surgery normally results in less pain. 

But regardless of which type of surgery you have, pain will happen. And will be most intense within the first week. This is a normal outcome of both surgery types. 

Most of your recovery and aftercare will revolve around managing the pain. In general, you'll experience 2 types of pain after either carpal tunnel surgery. Again, both are perfectly normal. Namely, they're referred to as:

• Incisional pain
• Pillar pain



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Pillar pain is felt in the thicker, fleshy sides of the cut. That’s where the transverse carpal ligament (the tissue which the surgeon cut) was attached to the wrist bones. And since muscles are also disturbed there, their disruption contributes to the pain. 

It may take 2-6 months for normal pillar pain to go away. In fact, how much pillar pain you have is one of the key factors affecting your recovery time. If pillar pain is excessive then it's considered a complication of carpal tunnel surgery. 

You can treat pillar pain very effectively with:

• pain medicines
• rest with your hand elevated
• wrist massage
• physical therapy

Pillar pain goes away much more  slowly  than incisional pain. So be patient. You might not notice a day-to-day change. But you will see differences from one week to the next.

You may get an  infection after carpal tunnel surgery, buy it's not very common. To avoid infection, be sure to take care of the area as outlined in your post-operative instructions. First and foremost, the instructions recommend keeping the bandages clean and dry. This is especially important in the first week after surgery. 

If an infection is causing pain after carpal tunnel surgery, the doctor will give you antibiotics. If the infection is especially bad, you might need another surgery to clean the infection from around the wound site.

Another uncommon complication of hand surgery is median nerve damage. It occurs more often with endoscopic carpal tunnel release surgery. Most times this pain goes away in 1-3 months. However, feelings like numbness, itching or burning may take its place. And those feelings can last years - or be permanent.

The typical nerve injury occurs to one of two smaller nerve branches in the hand. One controls the thumb muscles. The other carries sensations from the palm of the hand. Accidentally cutting or nicking a branch of the nerve causes a disturbance in the area that nerve controls.

Sometimes carpal tunnel pain never totally disappears after surgery. And sometimes it goes away but then comes back again in a few weeks or months. 

If you had carpal tunnel release surgery but still feel symptoms, you might be in this unlucky group. It’s not unusual to see patients where the surgery didn’t live up to its promises. Carpal tunnel doctors consider that a failed surgery. 

Failed surgeries happen about 50% of the time - that's if you measure "patient satisfaction". If a surgery fails, the doctor may recommend another, second carpal tunnel release surgery (called "revision surgery"). But the chances of success after a revision surgery is only 10-59%.

When a carpal tunnel surgery fails, most times the patient simply lives (and copes) with the remaining symptoms. This also includes coping with the physical, emotional, and financial scar of having a failed surgery.

The American Academy of Orthopedic Surgeons reports that over 500,000 carpal tunnel surgeries are performed each year. The Bureau of Labor Statistics and the National Institute for Occupational Safety & Health have another statistic. They say for those who had carpal tunnel release surgery, only 20-24% returned to their former job after surgery. 

- Bleak statistics indeed.

Pain after carpal tunnel surgery is common. In fact, almost all patients experience some degree of pain in their first few days. But persistent pain for several days to weeks is abnormal. You should contact your doctor if this happens.