Most people with carpal tunnel syndrome are treated without surgery. Surgery is considered only when:

• Symptoms have not improved after a long period of nonsurgical treatment. Generally, surgery is not considered until after 3 to 12 months of non-surgical treatment. But this assumes that you are having ongoing symptoms but no sign of nerve damage. Nerve damage would make surgery more urgent.
• Severe symptoms restrict normal daily activities, such as when there is a persistent loss of feeling or coordination in the fingers or hand, no strength in the thumb, or when sleep is severely disturbed by pain.
• There is damage to the median nerve (shown by nerve test results and loss of hand, thumb, or finger function) or a risk of damage to the nerve.

Carpal tunnel release surgery is used to reduce the pressure on the median nerve in the wrist. This is done by cutting the ligament that forms the top of the carpal tunnel. Cutting this ligament relieves pressure on the median nerve. Any other tissue (such as a tumor) that may be putting pressure on the median nerve can also be removed during surgery.

Should I have surgery for carpal tunnel syndrome?

After surgery, it is important to avoid any activities that may have caused carpal tunnel syndrome-or change the way you do them.

Surgery Choices

The most common surgery for relieving carpal tunnel symptoms involves cutting the transverse carpal ligament to relieve pressure on the median nerve in the wrist. Two approaches for this surgery are:

• Open carpal tunnel release surgery, which allows the doctor to see more of the inner tissues, including the full width of the transverse carpal ligament where it is to be cut. Open surgery requires an incision in the palm and wrist, which disturbs more of the tissues in the hand, requires a longer recovery period, and leaves a larger, potentially more bothersome scar than does endoscopic surgery. See an illustration of open carpal tunnel surgery.
• Endoscopic carpal tunnel release surgery, which requires only a small incision at the wrist (single-portal technique) or at the wrist and palm (two-portal technique), and which disturbs less tissue in the hand. Recovery is quicker than with open surgery, and the scars heal more quickly, are smaller, and tend to be less painful at 3 months after surgery.⁴ There has been a slightly higher rate of reoperation after endoscopic carpal tunnel surgery.⁵ See an illustration of endoscopic carpal tunnel surgery.

Some surgeons are now performing small- or mini-open release surgery. This requires a smaller incision than standard open carpal tunnel release surgery to minimize healing time and scar formation, but it also allows the surgeon to view the ligament directly during the surgery to minimize danger to the nerve itself. This procedure may be promising, but there are few studies comparing it to the open carpal tunnel or endoscopic procedures at this time.

What To Think About