Surgery

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

• Symptoms haven't improved after several weeks to months of nonsurgical treatment. 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.
  • There is no strength in the thumb.
  • 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 Syndrome: Should I Have Surgery?

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:¹

• Open carpal tunnel release surgery. Open surgery requires a longer recovery period and leaves a larger scar than endoscopic surgery. But there may be less chance of other complications.
• Endoscopic carpal tunnel release surgery. Recovery is quicker than with open surgery. The scars heal more quickly, are smaller, and tend to be less painful at 3 months after surgery. But there may be a slightly higher chance of needing another surgery later.

Some surgeons are now doing small- or mini-open release surgery. This requires a smaller incision than standard open carpal tunnel release surgery. It may reduce healing time and scarring. 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

Nerve tests (nerve conduction velocity test and electromyogram) are often completed before surgery is done. Surgery is more likely to be successful if the results from nerve testing point to carpal tunnel syndrome.

Your decision about whether to use open or endoscopic surgery depends on your doctor's experience with the procedures. Endoscopic carpal tunnel surgery uses very technical equipment and is most successful when the doctor has done the procedure many times.

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