Carpal Tunnel Syndrome - Surgery
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. In general, surgery is not considered until after several weeks to months of nonsurgical treatment. But this assumes that you are having
ongoing symptoms but no sign of nerve damage. Nerve damage would make surgery
- 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
- 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.
Carpal Tunnel Syndrome: Should I Have Surgery?
After surgery, it is important to avoid any activities that
may have caused carpal tunnel syndrome-or change the way you do them.
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:1
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, and requires a longer recovery
period. It leaves a larger scar than does
endoscopic surgery. But there may be less chance of other complications. See a picture 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. There
may be a slightly higher rate of reoperation after endoscopic carpal tunnel
surgery. See a picture of
endoscopic carpal tunnel surgery .
Some surgeons are now doing 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
What To Think About