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Carpal Tunnel Syndrome Health Center

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decision pointShould I have surgery for carpal tunnel syndrome?

Your decision about whether to have surgery will involve several issues, including the severity and duration of your condition, the risks of not treating chronic carpal tunnel syndrome, and the risks of having surgery. Consider the following when making your decision:

  • Nonsurgical treatments such as rest, wrist splints, and changing body mechanics effectively treat most cases of carpal tunnel syndrome.
  • Nerve testing is usually needed before considering surgery. If nerve function is being affected by carpal tunnel syndrome, carpal tunnel release surgery may help.
  • Most people who have surgery for carpal tunnel syndrome have fewer or no symptoms of hand pain and numbness after surgery. More than 70 out of 100 people are satisfied with their results, and as many as 90 out of 100 people have no night pain after surgery.1
  • Surgery may only provide partial relief when another medical condition, such as rheumatoid arthritis, obesity, or diabetes, is contributing to carpal tunnel syndrome.
  • Unless carpal tunnel symptoms become intolerable, a pregnant woman should delay surgery until after childbirth. After delivery, symptoms often disappear without treatment when pregnancy-related fluid buildup is relieved.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is the term used to describe a combination of tingling, numbness, weakness, or pain in the fingers, thumb, or palm, and sometimes in the forearm. These symptoms occur when there is pressure on a nerve (median nerve) at the wrist (carpal tunnel). See a picture of the wrist, carpal tunnel, and median nerve .

Carpal tunnel syndrome can often be linked to repetitive hand and wrist motion. Swelling in the wrist area, as during pregnancy or caused by a medical condition, can also cause or contribute to carpal tunnel symptoms. Chronic and severe carpal tunnel syndrome can lead to permanent nerve damage, pain, and muscle weakness and wasting (atrophy).

What are the risks of chronic, severe carpal tunnel syndrome?

Long-standing carpal tunnel syndrome can cause:

  • A loss of feeling and coordination in the fingers and hand. The thumb muscles can become weak and waste away (atrophy), making it difficult to grip or hold objects.
  • Permanent damage to the median nerve that results in difficulty using the hand. A damaged nerve may require surgery, which may not completely restore the feeling and coordination to the fingers and hand.

What kind of surgery is done for carpal tunnel syndrome?

The goal of surgery is to reduce the pressure on the median nerve in the wrist. The surgery used to relieve carpal tunnel symptoms is called carpal tunnel release . This procedure involves cutting the transverse carpal ligament to relieve pressure on the median nerve in the wrist.

Two approaches for this surgery are open and endoscopic. Each has advantages and disadvantages. When done by an experienced surgeon, endoscopic carpal tunnel release heals more quickly and does not leave the larger and potentially painful scar that open surgery produces.

See pictures of open carpal tunnel surgery and endoscopic carpal tunnel surgery .

How does surgical treatment success compare with wrist splint therapy?

Research suggests that for people with severe symptoms, open carpal tunnel release surgery provides more relief to more people than wearing a wrist splint at night for 6 weeks. In one study:2

  • At 3 months after treatment, 80% of surgery recipients and 54% of splint therapy recipients reported successful relief of severe symptoms.
  • At 18 months after treatment, 90% of surgery recipients and 75% of splint therapy recipients reported treatment success.
  • At 18 months after treatment, 41% of splint therapy recipients had since chosen surgery.

If you need more information, see the topic Carpal Tunnel Syndrome.

If you have severe carpal tunnel syndrome, your treatment choices are:

  • Continue to treat your condition nonsurgically using some combination of rest, ice, medicine, wrist splints, healthier body mechanics when doing manual tasks, and working with your doctor to manage other health conditions that may contribute to carpal tunnel syndrome.
  • Have surgery, which has the best chance of succeeding when followed by rest and then rehabilitation exercises, as prescribed by your doctor.

The decision about whether to have carpal tunnel surgery takes into account your personal feelings and the medical facts.

Deciding about carpal tunnel surgery
Reasons to have carpal tunnel surgery Reasons not to have carpal tunnel surgery

It is reasonable to consider carpal tunnel surgery if you have:

  • Median nerve damage (shown by nerve test results and loss of hand or finger function).
  • Severe or long-standing carpal tunnel syndrome, increasing your risk of developing permanent median nerve damage.
  • Carpal tunnel symptoms after a long period (up to a year) of consistent nonsurgical treatment.
  • Severe symptoms (such as persistent loss of feeling or coordination in the fingers or hand, or no strength in the thumb) that restrict your normal daily activities.
  • A tumor or other growth that needs to be removed.

Are there other reasons you might want to have carpal tunnel surgery?

You may decide not to have surgery:

  • If your thumb muscles have been severely weakened or wasted away, because your hand strength and function may be limited even after surgery.
  • Because of the risks involved. A few people who have carpal release surgery have some kind of complication including infection or anesthesia-related problems. Fewer than 1 out of 100 have serious problems such as injury to nerves, blood vessels, or tendons.3
  • Because there is no guarantee of success. In rare cases, the symptoms of pain and numbness may return (the most common complication).
  • Because a postsurgery rest from activity is necessary after surgery. Your recovery time and surgery success will depend on whether you are returning to demanding, repetitive tasks afterward.
    • Endoscopic surgery recovery ranges from a couple of days to more than 4 weeks.
    • Open surgery recovery ranges from a few days to 12 weeks.

Are there other reasons you might not want to have carpal tunnel surgery?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about carpal tunnel syndrome surgery. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I have been consistently following the instructions prescribed by my doctor or physical therapist for at least 3 months. Yes No Unsure
Nonsurgical treatment is not controlling my symptoms. Yes No Unsure
I have severe pain, weakness, or numbness that has been making daily life difficult. Yes No Unsure
I am disabled by carpal tunnel syndrome. Yes No NA*
I have to severely limit my activities because of my condition. Yes No NA
I don't have median nerve damage, but I am worried I will develop it. Yes No Unsure
I have been diagnosed with median nerve damage. Yes No Unsure
I am comfortable with the idea of having surgery. Yes No Unsure
I have carpal tunnel syndrome that has caused pain, weakness, and numbness for longer than a year. Yes No Unsure

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason for having or not having surgery for carpal tunnel syndrome.

Check the box below that represents your overall impression about your decision.

Leaning toward having carpal tunnel surgery

 

Leaning toward NOT having carpal tunnel surgery

         

Citations

  1. Katz JM, Simmons BP (2002). Carpal tunnel syndrome. New England Journal of Medicine, 346(23): 1807–1812.

  2. Gerritsen AAM, et al. (2002). Splinting vs. surgery in the treatment of carpal tunnel syndrome: A randomized controlled trial. JAMA, 288(10): 1245–1251.

  3. Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).

Author Shannon Erstad, MBA/MPH
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer Patrick J. McMahon, MD - Orthopedics
Specialist Medical Reviewer David Pichora, MD, FRCSC - Orthopedic Surgery
Last Updated October 29, 2008

WebMD Medical Reference from Healthwise

Last Updated: October 29, 2008
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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