Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
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
- Severe symptoms restrict normal daily activities, such
- There is a persistent loss of feeling or coordination in the fingers or
- There is decreased strength in the thumb.
- Sleep is severely disturbed by
- 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?
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:
- 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
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.
Kathleen Romito, MD - Family Medicine
Herbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery
October 2, 2012
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