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Carpal Tunnel Syndrome
- Topic Overview
-
Health Tools
- Cause
- Symptoms
- What Happens
- What Increases Your Risk
- When To Call a Doctor
- Exams and Tests
- Treatment Overview
- Prevention
- Home Treatment
- Medications
- Surgery
- Other Treatment
- Other Places To Get Help
- Related Information
- References
- Credits
Most people with carpal tunnel syndrome are treated without surgery. Surgery is considered only when:
- Symptoms have not improved after a long period of nonsurgical treatment. In general, surgery is not considered until after several weeks to months of nonsurgical treatment. But 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, no strength in the thumb, or when 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 release surgery
is used to reduce the
pressure on the median nerve in the wrist. This is done by cutting the ligament
that forms the top of the carpal tunnel. Cutting this ligament relieves
pressure on the median nerve. Any other tissue (such as a tumor) that may be
putting pressure on the median nerve can also be removed during surgery.
After surgery, it is important to avoid any activities that may have caused carpal tunnel syndrome—or change the way you do them.
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, which allows the doctor to see more of the inner
tissues, including the full width of the transverse carpal ligament where it is
to be cut. Open surgery requires an incision in the palm and wrist, which
disturbs more of the tissues in the hand, and requires a longer recovery
period. It leaves a larger scar than does
endoscopic surgery. But there may be less chance of other complications. See a picture of
open carpal tunnel surgery.
- Endoscopic carpal tunnel release surgery, which requires only a small incision at the
wrist (single-portal technique) or at the wrist and palm (two-portal
technique), and which disturbs less tissue in the hand. Recovery is quicker
than with open surgery. And the scars heal more quickly, are smaller, and tend
to be less painful at 3 months after surgery. There
may be a slightly higher rate of reoperation after endoscopic carpal tunnel
surgery. See a picture of
endoscopic carpal tunnel surgery.
Some surgeons are now doing small- or mini-open release surgery. This requires a smaller incision than standard open carpal tunnel release surgery to minimize healing time and scar formation. 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
When surgery is considered necessary to treat severe carpal tunnel syndrome, it usually relieves symptoms.
Nerve tests (nerve conduction velocity test and electromyogram) are usually completed before surgery is done. Surgery is more likely to be successful if the results from nerve testing point 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.
There are many health problems, such as rheumatoid arthritis or diabetes, that can cause symptoms similar to carpal tunnel syndrome. If you have a health problem that causes severe carpal tunnel symptoms or makes symptoms worse:
- Ongoing treatment for that problem is needed to help control those symptoms.
- Surgery may help prevent median nerve damage and give you partial relief from carpal tunnel symptoms.
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.
| By: | Healthwise Staff | Last Revised: October 21, 2010 |
| Medical Review: | Adam Husney, MD - Family Medicine David Pichora, MD, FRCSC - Orthopedic Surgery | |
© 1995-2011 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
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