Do I Need Surgery for My Carpal Tunnel Syndrome?

If the pain has become unbearable and no therapeutic or medical treatments have worked, it might be time to consider surgery for your carpal tunnel syndrome.

Carpal tunnel syndrome is a compression of the median nerve that runs through your wrist.

Women are three times more likely to develop the condition, and people in assembly-line work often are affected by it. The result is nagging pain, tingling and numbness in the hand, fingers or thumb. Upon diagnosis, your doctor may recommend a night splint, medical treatments and a variety of therapies to alleviate the pain.

Think of the hand as a plant, while the median nerve, which supplies power and feeling to the hand, is similar to a garden hose. If the garden hose is compressed, then the plant will not receive what it needs to function. This is when patients have symptoms. Surgery is designed to take the pressure off the hose and allow the water to flow.

At centers such as the USC Hand Center at Keck Medicine of USC, certified hand therapists combine occupational therapy (OT) and physical therapy (PT) techniques to assess your injury and restore function. Once you have exhausted these options, surgery may be the only way to relieve pain or cure your carpal tunnel syndrome. Only in rare cases will your doctor suggest surgery if your symptoms have just started.

Do you need surgery?

You may be unsure of whether surgery is the right option for you. We asked Rachel Lefebvre, MD,  an orthopedic surgeon at Keck Medicine of USC and assistant professor of clinical orthopedic surgery at the Keck School of Medicine of USC, to weigh in on these questions:

• How do you know if the issue is carpal tunnel or something else?

“Often hearing about your symptoms and performing a physical exam are enough to tell us if the problem is carpal tunnel or something else. Sometimes we need additional tests — like a nerve connection study — to understand the severity and learn if there are other nerve problems contributing to your symptoms.

• Will surgery cure my carpal tunnel syndrome?

“Surgery is a reliable way to stop the compression of the nerve. Patients with less severe carpal tunnel syndrome often have pain relief, better sensation and less night time awakenings after the surgery. If carpal tunnel syndrome has been going on for a while and is advanced, we may still recommend surgery. But in severe cases, the goal of surgery is to stop the progression of nerve injury. This means that numbness and weakness may be permanent but will not progress further after surgery releases the pressure on the nerve.”

• Can carpal tunnel recur after surgery?

“Extremely rarely. For most patients, surgical release and control of environmental factors that may place their wrists in a position of stress will banish their carpal tunnel syndrome. There are a very small number of patients who need a second surgical procedure to release the carpal tunnel a second time.”

• What are the risks of surgery on use and mobility? What is my recovery time for carpal tunnel release?

“The surgery is a same-day procedure: patients leave the recovery room to go home within a few hours of surgery. Patients are encouraged to use their fingers and arm for light activity right after surgery. I tell my patients to refrain from activities that break a sweat and to not lift anything heavier than a can of soda with their operative hand. After the skin has completely healed (usually in about two weeks), I don’t have any restrictions on what you can do. Most patients do not need formal hand therapy after surgery, but if recovery is slower than usual, I refer my patients to a hand therapist to help us on the path to wellness.

How is surgery performed?

“Carpal tunnel release” is the term for surgery that helps relieve or eliminate pain by dividing a fibrous band near the wrist called the flexor retinaculum. Your doctor will release the ligament through an incision on the inside of the wrist.

What is my recovery time for carpal tunnel release?

The surgery can be performed on an outpatient basis. You’ll be able to use your fingers and hand for basic activities immediately after surgery.

After two weeks, you can resume other normal activities — except those that put pressure on the palm. Six weeks post-surgery, you should be fully recovered, though you might feel some discomfort during pushups and other strenuous activities. According to Lefebvre, this is not because of the recovery of the nerve but rather recovery from the incision.

“For patients with longstanding nerve compression, it may take up to a year to get sensation and power back,” Lefebvre explains.

Is there anything I can do to make sure my carpal tunnel syndrome doesn’t return?

Injections can be helpful but not always successful in the early phase of carpal tunnel syndrome. Therapy does not play a large role in treatment, however, activity modification and mindfulness, including postural control, stress relaxation, diet and exercise, can be successful.

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