Carpal Tunnel Surgery
in Rockhampton

What is going on

Carpal tunnel syndrome is compression of the median nerve as it crosses the wrist. Patients typically describe night-time numbness or pins-and-needles in the thumb, index and middle fingers, weakness when gripping, and waking to shake the hand to relieve symptoms. The condition is common in middle age, in pregnancy, and in occupations that involve repetitive gripping. Diagnosis is usually clinical, often confirmed with nerve conduction studies where the picture is unclear or surgery is being planned. Most patients have tried wrist splints, activity modification or a corticosteroid injection before surgery is offered.

Not sure if this is the right diagnosis? The wrist pain hub triages the differential by anatomical location.

What the operation involves

Carpal tunnel release divides the transverse carpal ligament, the firm band of tissue that forms the roof of the carpal tunnel, taking pressure off the median nerve. The practice performs the operation through a small open incision in the palm, usually under local anaesthetic with light sedation, as a day case. Surgery takes around 15 minutes; the wound is closed with stitches that are removed at around two weeks, and dressed with a soft bulky dressing. Full clinical detail and what to expect on the day is on the education page, and the carpal tunnel and nerve compression education page covers the underlying condition.

For full clinical detail — incision, anaesthetic, post-operative instructions and the printable patient handout — see the carpal tunnel surgery education page or the wrist surgery overview.

How this case is handled

Carpal tunnel release is a well-suited day case operation for patients travelling from out of town. The practice tries to coordinate the consult, surgical booking and pre-admission paperwork into a single visit where it can be arranged. Post-operative review is typically at six weeks; this six-week review is aftercare and is included in the surgical fee. All carpal tunnel patients are seen by Ruby Doolan at Extend Rehabilitation for the first dressing change and scar care; this is built into the routine pathway.

Fees, Medicare rebates and the surgery-quote process are on the fees page. The case for seeing a fellowship-trained surgeon — and what fellowship training adds — is set out separately. GPs can find the referral pathway, urgency triage and what to include in the letter on the referrer page.

What this operation is billed under

The procedure is covered by the following Medicare Benefits Schedule items. Surgeon, anaesthetist, assistant, hospital and prosthesis fees are quoted separately and in writing before surgery — see the fees page for the practice's quote process and an explanation of why surgical fees follow the Australian Medical Association schedule. Surgery does not proceed without itemised written informed financial consent.

Item 39331 Carpal tunnel release (primary)

Covers all primary carpal tunnel decompressions — open or endoscopic — since the previous endoscopic-specific item was consolidated

Item 39332 Revision carpal tunnel release

Repeat carpal tunnel decompression after a previous release

Patient questions we hear most

• What's the difference between open and endoscopic carpal tunnel release?

  Both procedures divide the same ligament and decompress the same nerve. Open release uses a small palmar incision to visualise the structures directly; endoscopic release uses one or two smaller incisions and a camera. Published outcomes are similar in symptom relief and complication rates. The practice performs open release as the standard approach because direct visualisation makes injury to the median nerve and to the recurrent motor branch extremely uncommon, and the small palmar scar settles to a barely visible line within a few months.

• What's the chance my symptoms will come back after carpal tunnel surgery?

  True recurrence after a properly executed open release is uncommon — the divided ligament does not re-form into the same constricting band. What patients sometimes notice is a slow, partial return of symptoms over many years if the underlying contributors (occupation, weight, diabetes, pregnancy in some patients) persist. Persistent or returning symptoms after surgery are investigated carefully — sometimes the original diagnosis was incomplete and another nerve site is also involved. Any concern post-operatively is worth raising at review.

• How much does carpal tunnel surgery cost? What does Medicare cover?

  Carpal tunnel release fees vary with the anaesthetic. Under local anaesthetic — Dr Hirpara performs the block himself — there is no anaesthetist fee; under a general anaesthetic, a separate anaesthetist gap applies. The surgeon, hospital and consumable fees are the same in either case. The practice quotes the surgical fee in writing before booking — the Medicare item, the rebate and the out-of-pocket gap each shown separately. Dr Hirpara's surgical fees follow the Australian Medical Association schedule, which is higher than the Medicare scheduled fee; the fees page explains why. Surgery does not proceed without itemised written informed financial consent.

• When can I drive again after carpal tunnel surgery?

  Driving requires a safe grip on the wheel and the ability to manage indicators and gears. Most patients are comfortable driving an automatic vehicle within a few days when the dressing has been reduced and the hand is comfortable; manual cars take a little longer. Practical signs you are likely safe to drive: you can grip the wheel firmly with the operated hand, perform an emergency stop without needing to protect the hand, you are off prescription pain medication, and the bulky dressing has been reduced to a small adhesive cover. The practice does not certify fitness to drive for insurance purposes — driving fitness is a decision between the patient, the GP and the insurer — but the question is discussed at the post-operative review.

• Can both wrists be operated on at the same time?

  The practice prefers to operate on one hand at a time. Many patients with bilateral symptoms find the unoperated side settles considerably after the first hand is released — relief from the wakeful nights, restored sleep posture, and reduced overall nerve sensitisation often calm the contralateral hand without further intervention. Practically, releasing both hands at once also makes the first week harder than it needs to be: dressings on both hands make cooking, dressing and basic self-care surprisingly difficult. The worse hand is usually done first; the second hand is reviewed at the post-operative visit and only operated on later if it hasn't settled.

• What is "pillar pain" — should I be worried about it?

  Pillar pain is a discomfort or tenderness in the heel of the hand on either side of the scar, usually appearing in the first few weeks after surgery and settling over two to three months as the divided ligament reforms with scar tissue. It's a normal part of recovery rather than a complication; the cause is thought to be a small change in the geometry of the small bones of the wrist as the transverse ligament releases its tension. Activity is comfortable through it, and it resolves on its own in nearly all patients.

• Do I need physiotherapy or hand therapy after carpal tunnel surgery?

  Yes — every patient sees the on-site hand therapist for the first dressing change, scar management instruction, and a structured set of post-operative exercises to keep the fingers gliding and the scar mobile. Hand therapy is integrated into the post-operative pathway rather than offered as an extra. Additional sessions are scheduled where the recovery is slower than expected — a stiff hand, a tender or hypertrophic scar, or any wound concern. Hand therapy is provided by Ruby Doolan through Extend Rehabilitation, in the same suite as Dr Hirpara's rooms.

More general questions about appointments, fees and the practice on the FAQ page.