Should I have surgery for carpal tunnel syndrome?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
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:
- Rest, ice, exercises, medication, 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. The overall success rate for either endoscopic or open surgery has been reported as high as 95%.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.
Medical Information
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 occasionally in the forearm. These symptoms occur when there is pressure on a nerve (median nerve) at the wrist (carpal tunnel). See an illustration of the wrist, carpal tunnel, and median nerve
.
Carpal tunnel syndrome can often be linked to repetitive hand or finger 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, muscle weakness and wasting (atrophy), and pain.
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
Two approaches for this surgery are open and endoscopic. Each has advantages and disadvantages. When performed 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 illustrations of open 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.
Your Information
If you have severe carpal tunnel syndrome, your treatment choices are:
- Continue to treat your condition non-surgically using some combination of rest, ice, exercises, medication, wrist splints, healthier body mechanics when doing manual tasks, and working with your health professional 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 health professional.
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 non-surgical 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 tumour 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. About 5% of people who have carpal release surgery have some kind of complication including infection; injury to nerves, blood vessels, or tendons; or anesthesia-related problems.1
- 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.
Wise Health 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 doing the exercises prescribed by my health professional or physiotherapist for at least 6 weeks. Yes No Unsure Non-surgical treatment is not controlling my symptoms. Yes No Unsure I have severe pain, weakness, or numbness that has been making daily life difficult for at least 2 months. 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
Return to the topic Carpal Tunnel Syndrome.
| Author: | Douglas Dana Monica Rhodes | Last Updated: January 11, 2007 |
| Medical Review: | William M. Green, MD - Emergency Medicine Adam Husney, MD - Family Medicine David Pichora, MD, FRCSC - Orthopedic Surgery | |
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