Free Carpal Tunnel Release Consent Form Template

Informed Consent for Carpal Tunnel Release Surgery

Patient Informed Consent Documentation

Patient and Surgical Information

Nature and Purpose of the Procedure

Carpal tunnel syndrome (CTS) results from compression of the median nerve as it passes through the carpal tunnel, a rigid fibro-osseous channel at the base of the wrist formed by the carpal bones and the transverse carpal ligament (flexor retinaculum). The median nerve supplies sensation to the thumb, index finger, middle finger, and the radial half of the ring finger, and provides motor innervation to the thenar muscles of the thumb. Sustained compression causes progressive nerve ischemia, leading to numbness, tingling, nocturnal pain, and weakness or atrophy of the thenar eminence in severe cases. Carpal tunnel release (CTR) is the definitive surgical treatment. The procedure may be performed using an open technique (a 2 to 4 cm incision at the base of the palm) or an endoscopic technique (ECTR, using a small camera and specialized instruments through a smaller incision). In both approaches, the transverse carpal ligament is divided completely, immediately decompressing the median nerve. The procedure is performed under local anesthesia with or without a tourniquet (WALANT technique is increasingly common), is typically completed in 15 to 30 minutes, and is performed as a day-surgery case.

Material Risks and Potential Complications

Recovery and Return to Activity

A bulky dressing is applied for the first 2 weeks followed by wound check and suture removal. Most patients return to light activities and desk work within 1 to 2 weeks. Heavy manual work, repetitive gripping, and vibrating tools should be avoided for 4 to 6 weeks. Grip strength typically returns to baseline by 3 to 4 months. Night symptoms usually resolve within days to weeks. Resolution of daytime numbness may take 3 to 6 months, and in cases of severe pre-operative nerve damage, recovery may be incomplete.

Non-Surgical Alternatives

Expected Benefits

The primary expected benefit of carpal tunnel release is reliable decompression of the median nerve, which is expected to resolve or substantially improve nighttime numbness and tingling, daytime sensory symptoms, and, where thenar weakness has developed, allow partial to full recovery of grip and pinch strength. Symptom relief typically begins within days to weeks postoperatively. The procedure has a high success rate, with approximately 90 percent of patients reporting significant or complete resolution of symptoms.

Right to Refuse or Withdraw Consent

You have the right to refuse this procedure or withdraw your consent at any time before the procedure begins without penalty or adverse effect on your medical care. Your surgeon will discuss non-surgical management alternatives with you if you choose not to proceed.

Questions and Understanding Confirmation

I confirm that I have had the opportunity to read this consent form and ask questions of my surgeon. All my questions have been answered to my satisfaction. I understand the recovery timeline and activity restrictions, and I believe I am making an informed and voluntary decision.

Language Access and Interpreter Services

If English is not your primary language or if you require assistance communicating, a qualified medical interpreter is available at no cost. Please notify your care team before signing this document.

Copy of Consent Acknowledgment

I acknowledge that I have been offered a signed copy of this informed consent form for my own records. I may request an additional copy at any time from the facility or clinical records department.

Patient Authorization

I have been informed of the carpal tunnel release procedure, its expected benefits, the risks described above, and the available non-surgical and surgical alternatives. I consent to undergo carpal tunnel release surgery on the hand(s) indicated above.

Signatures and Verification