Too Old for Carpal Tunnel Surgery? No Such Thing
Todnem says she realizes that many patients, young and old, would prefer not to have surgery, but says that physicians can determine relatively easily which patients would benefit from surgery and which can wait.
Proper selection of patients who are candidates for surgery is critical, Todnem says. If there is permanent loss of sensation, that is a sign that the median nerve has become "entrapped," causing the muscles to waste. In that case, surgery is recommended, she says.
An exam using an electrical device that measures how fast a signal travels down the median nerve, can also help determine which patients would be best suited for surgery, she says.
"For patients with very slight symptoms, there should be no hurry to get an operation," Todnem says. "They can wait and see, and when the pressure around the median nerve decreases, the situation will normalize. Some patients will get better."
In the meantime, the best advice for those patients is to work less with the hands, Todnem says.
Stan Pelofsky, MD, president elect of the American Association of Neurological Surgeons (AANS), who was not involved in the study, says it demonstrates that age alone should not be a reason for foregoing surgery.
In the past, surgeons have been reluctant to operate on older patients for fear of complications resulting from other medical conditions, or from putting the person to sleep. But today, the surgery can be done safely and easily with a local anesthetic, which leaves the patient awake, he says.
Pelofsky notes that some patients in the study did appear to improve despite receiving no treatment, and that more conservative therapies -- such as splints, steroids, and decreasing work with hands -- can help some patients.
But many patients live with carpal tunnel syndrome for many years, he says, at significant cost to their quality of life. While surgery should not be the first option, it can be an alternative -- no matter how old the patient is.
If a patient has symptoms, a diagnosis of carpal tunnel syndrome, and conservative therapies haven't worked, "surgery is an excellent option, even if the patient is 80 years old," Pelofsky tells WebMD.