Too Old for Carpal Tunnel Surgery? No Such Thing

Medically Reviewed by Jacqueline Brooks, MBBCH, MRCPsych

Oct. 27, 2000 -- Eighty years old, with no feeling in her hand, the patient was just one of many elderly men and women that Kari Todnem, MD, had treated for carpal tunnel syndrome -- an inflammation causing pain, numbness, or tingling in the wrist, hand, and fingers.

"She couldn't do any of her favorite activities, like crocheting or knitting," recalls Todnem, a physician in the department of clinical neurophysiology at the University Hospital of Trondheim in Norway.

Todnem explains that in this patient, the median nerve, which runs down a "tunnel" of muscles in the arm and sends sensory signals to the fingers and hands, was entirely trapped by the inflammation of surrounding tissues. The result was a complete lack of feeling and wasting of the muscle at the base of the thumb, which helps move the hands and fingers.

Conventional therapies didn't help. But when Todnem recommended surgery to correct the condition, she confronted another obstacle. "The surgeon declined to operate because he said she was too old," Todnem tells WebMD.

The experience stuck with Todnem, and this month she and her colleagues have published a study in a recent issue of the journal Muscle and Nerve, showing what she had suspected: many elderly patients can benefit from surgery to correct carpal tunnel syndrome.

In the study, three groups of patients were compared: One group of patients aged 70 to 89 received surgery; a second group aged 30 to 69 also received surgery; and a third group of patients aged 25 to 83 who did not receive surgery.

The elderly patients had significant improvement after surgery, comparable to the younger patients who had surgery. Both young and old patients who did not receive surgery also improved, but not as much as the group that went under the knife, according to the study.

The conclusion: "Elderly people who are having a hard time should get an operation," Todnem tells WebMD.

"Patients with pain and numbness in the hands, problems with hand crafts, buttoning clothes, or handling small objects should have surgery," she says. "This is a small operation performed with local anesthesia. The prognosis is excellent, and numbness will disappear quickly and [sensations] will normalize."

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.

The incidence of carpal tunnel syndrome appears to be on the rise, though exact figures are hard to come by. One British study from 1998 found that 7% to 16% of patients experience carpal tunnel syndrome, with people over age 54 at higher risk than younger adults.

According to the AANS, carpal tunnel syndrome can be caused by any repetitive motions that cause swelling, thickening, or irritation of the membranes around the tendons in the carpal tunnel of the hands. These include repetitive and forceful grasping of the hands, and consistent bending of the wrist.

Other causes include broken or dislocated bones in the wrist, arthritis, thyroid gland imbalance, diabetes, and hormonal changes associated with pregnancy. In some cases, no cause is found, according to the AANS.