Carpal Tunnel Syndrome: Should I Have Surgery?
Carpal Tunnel Syndrome: Should I Have Surgery?Skip to the navigationYou may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Carpal Tunnel Syndrome: Should I Have Surgery?Get the factsYour options- Have surgery for
carpal tunnel syndrome.
- Don't have
surgery. Use rest, ice, medicine, wrist splints, and new ways to do some
tasks.
Key points to remember- Home treatments may be all you need if you've had mild
symptoms for a short time. You may be able to treat
carpal tunnel syndrome with rest, ice, medicine, and
wrist splints. You also can learn to do some tasks in a way that doesn't hurt
your wrist. Surgery may be a better choice if you've had very bad symptoms for
a long time.
- Surgery for carpal tunnel syndrome may give you only a little
relief if your symptoms are caused by other health problems, such as
rheumatoid arthritis,
hypothyroidism, or
diabetes. Treating these problems often makes carpal
tunnel symptoms get better or go away. But in some cases, you still might need
surgery.
- Sometimes surgery is needed to prevent lasting nerve
damage. You will likely have a nerve test to see if you need surgery.
- Symptoms of carpal tunnel syndrome in pregnant
women often go away after childbirth. Unless your symptoms are very bad, you
may want to wait and see if your symptoms go away after you have the baby.
FAQs Carpal tunnel syndrome is a nerve problem that causes tingling, numbness, weakness, or pain
in the fingers, thumb, or palm, and sometimes the forearm. These symptoms are
caused by pressure on a nerve (median nerve) in the wrist (carpal tunnel). This problem is often linked
to hand and wrist motions that you do a lot. These are called repetitive
motions. Swelling or fluid retention in the wrist-which can happen during pregnancy
or because of a health problem-also can cause carpal tunnel symptoms or make
them worse. Severe carpal tunnel syndrome that lasts a long time can lead to
permanent damage to the
median nerve. This can make it hard for you to use
your hand. You may have: - Pain.
- Weak thumb muscles. This
makes it hard for you to grip or hold objects.
- Loss of feeling and
ability to use your fingers and hand well.
Surgery reduces the pressure on the median nerve in the wrist. The doctor cuts
a ligament to relieve the pressure on the nerve. The surgery is
called carpal tunnel release. It can be done in one of two
ways: - Open surgery: Your doctor makes a small cut (incision) in the palm of
your hand.
- Endoscopic surgery: Your doctor makes one small incision in the wrist, or
one small incision in the wrist and one in the palm. He or she puts a thin tube with a camera attached (endoscope) into the incision. Surgical tools are put in
along with the scope.
You may decide to have surgery if
you've had very bad symptoms for a long time and other treatments haven't
helped. Sometimes surgery is needed to prevent lasting nerve
damage. You will likely have a
nerve test to see if you need surgery. Most people who have
surgery for carpal tunnel syndrome have less or no pain and numbness in their
hand and better hand function after surgery.footnote 1 It's not clear how long you should try nonsurgical treatment before considering surgery. But after people who have severe carpal tunnel syndrome have surgery, they typically have fewer symptoms and better hand function than people who continue using wrist splints or a combination of medicine and hand therapy.footnote 2 Both types of
surgery-open and
endoscopic-work equally well to improve
symptoms.footnote 3 Talk to your doctor about which surgery
might be best for you. Major problems from surgery can happen, but
they are rare. About 1 person out of 100 has a major problem after surgery,
such as nerve damage, while 99 out of 100 people don't.footnote 3 You can
try several home treatments to help relieve your symptoms. This may be all you
need to do for mild symptoms of carpal tunnel syndrome. Doctors suggest that
you try these treatments for 3 to 12 months before you think about having
surgery. It often helps to try several treatments at the same time. You may try to: - Rest your hand for 1 or 2 weeks.
Stop activities that hurt.
- Put ice on the
palm of your hand and wrist for 10 to 15 minutes at a time.
- Take
nonsteroidal anti-inflammatory drugs (NSAIDs), such as
naproxen or ibuprofen. Studies
haven't shown NSAIDs to be effective for carpal tunnel syndrome, but they may help
relieve your symptoms. Talk to your doctor before taking
NSAIDs. They can cause side effects. Be safe with medicines. Read and follow all instructions on the label.
- Change the way you do certain hand motions.
- Wear a
wrist splint. It's usually worn at night, but you can
wear it during the day.
Other choices - You can work with a
physical therapist to learn how to do activities in a
new way.
- If these home care treatments don't help, you may be able
to take
corticosteroid shots or pills to improve your
symptoms.
- You can try
yoga.
- Symptoms of carpal tunnel syndrome
in pregnant women often go away after childbirth. Unless your symptoms are very
bad, you may want to put off having surgery and see if your symptoms go away
after you have the baby.
Rest,
ice, and other home treatments may be all you need if you've had
mild symptoms for a short time. Your doctor may also suggest that you try wrist splints or corticosteroids to avoid or delay surgery. - Splints are easy and inexpensive, and there is little risk to trying them.
- Corticosteroid shots and pills give short-term relief from
symptoms.footnote 4
Your doctor might recommend surgery if: - You've had very bad symptoms for a long time,
so you're at risk of having lasting nerve damage.
- Test show that
you have nerve damage.
- A wrist splint, medicines, and other
treatments haven't helped your symptoms.
Compare your options | |
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What is usually involved? |
| |
|---|
What are the benefits? |
| |
|---|
What are the risks and side effects? |
| |
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Have surgery for carpal
tunnel syndrome Have surgery for carpal
tunnel syndrome - You have
local anesthetic, so you are awake but won't have
pain.
- You go home on the same day.
- You need to avoid heavy use of your hand
for up to 3 months.
- If you have open surgery on your dominant hand and you do repeated actions at work, you may be able to return to work in 6 to 8 weeks. If the surgery is on the other hand and you do not do repeated actions at work, you may be able to return to work in 7 to 14 days. If you have endoscopic surgery, you may be able to return to work sooner than with open surgery.
- Surgery can make symptoms get
better or go away for most people.
- It can prevent lasting nerve damage.
- Surgery doesn't
always help.
- Your symptoms may come
back.
- Major problems from surgery, such as infection or a problem from
anesthesia, are rare.
Try other treatments
Try other treatments
- You can try several home
treatments to ease symptoms of carpal tunnel syndrome, including:
- Rest.
- Ice.
- A
wrist splint.
- New ways of doing
tasks.
- Yoga.
- You may get
corticosteroids.
- If you are
pregnant, you can wait to see if the problem goes away after childbirth.
- You don't have the risks of
surgery.
- You may not have to take time off from work.
- You don't have the expense of surgery.
- Other treatments
might not work.
- If you have very bad symptoms and wait too long, you could have
lasting nerve damage.
- Temporary increase in pain, or a small chance of nerve damage, after a corticosteroid shot.
One of the
most annoying things about my carpal tunnel syndrome is the night pain in my
hands. If I don't wear the splints, it wakes me up almost every night. But with
the splints, I can get a good night's sleep, and my doctor says that my thumb
and hand strength are not too bad. I'm nervous about any kind of surgery, so
when my doctor said it would be okay to wait awhile, I said, "Great." If the
splints stop working, though, I'll probably be back in my doctor's office!
I own a landscaping business, and a few
months ago I started having a lot of pain when putting in backyard fences. Then
the pain started to wake me up at night and keep me awake. My doctor said I had
a classic case of carpal tunnel syndrome. I tried some of the home treatments
that she recommended, and the problem didn't get any worse, but it didn't get
any better, either. So I went back and asked about surgery. It sounds like the
surgery has a good chance of taking care of the problem, so I'm going to give
it a try. When you own your own company, it's too expensive to keep missing
work. But I'll have to wait till the slow season, because I'll have to take
a few weeks' break to recover. I thought
for sure that I was going to have to have surgery for my carpal tunnel. I'm an
order-taker for a mail-order catalog company, which means I type a lot, and my
symptoms were really getting bad. My fingers were numb, so I kept hitting the
wrong keys on the keyboard and making errors. The pain was waking me up at
night, and it was even starting to hurt during the day. I went to my boss and
the human resources manager at work, and together we worked out a job-sharing
arrangement that lets me take orders for part of the day and work in the mail
room the rest of the day. I am going to see how that helps, along with the
exercises and the splints. When I dropped my third coffee cup in a
week, I decided it was time to do something about my hands. I've had this
carpal tunnel problem for a couple of years now, and I'm tired of wearing the
splints and getting occasional steroid shots in my wrists. My doctor says that
whether I have surgery or not is really up to me at this point. I think I'm
ready for it. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery Reasons not to have surgery I tried other treatments, but my pain is still bad. I can live with the pain while I give other treatments some more time to work. More important Equally important More important I don't mind having surgery if it can get rid of my symptoms. I just don't want to have surgery. More important Equally important More important I'm not worried about the small chance of problems from surgery. I don't want to take even a small chance of something going wrong with surgery. More important Equally important More important I'm afraid of having lasting nerve damage from carpal tunnel syndrome. I'm not worried that I'll have lasting nerve damage from carpal tunnel syndrome. More important Equally important More important My other important reasons: My other important reasons: More important Equally important More important Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having surgery NOT having surgery Leaning toward Undecided Leaning toward What else do you need to make your decision?1.
How sure do you feel right now about your decision? Not sure at all Somewhat sure Very sure Your SummaryHere's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. Next stepsWhich way you're leaningHow sure you areYour commentsKey concepts that you understoodKey concepts that may need reviewCredits | Author | Healthwise Staff |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | Herbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery |
|---|
References Citations - Ashworth NL (2014). Carpal tunnel. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1114/overview.html. Accessed October 2, 2014.
- Huisstede BM, et al. (2010). Carpal tunnel syndrome. Part II: Effectiveness of surgical treatments-A systematic review. Archives of Physical Medicine and Rehabilitation, 91(7): 1005-1024.
- Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).
- Piazzini DB, et al. (2007). A systematic review of the conservative treatment of carpal tunnel syndrome. Clinical Rehabilitation, 21(4): 299-213.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Carpal Tunnel Syndrome: Should I Have Surgery?Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. - Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the FactsYour options- Have surgery for
carpal tunnel syndrome.
- Don't have
surgery. Use rest, ice, medicine, wrist splints, and new ways to do some
tasks.
Key points to remember- Home treatments may be all you need if you've had mild
symptoms for a short time. You may be able to treat
carpal tunnel syndrome with rest, ice, medicine, and
wrist splints. You also can learn to do some tasks in a way that doesn't hurt
your wrist. Surgery may be a better choice if you've had very bad symptoms for
a long time.
- Surgery for carpal tunnel syndrome may give you only a little
relief if your symptoms are caused by other health problems, such as
rheumatoid arthritis,
hypothyroidism, or
diabetes. Treating these problems often makes carpal
tunnel symptoms get better or go away. But in some cases, you still might need
surgery.
- Sometimes surgery is needed to prevent lasting nerve
damage. You will likely have a nerve test to see if you need surgery.
- Symptoms of carpal tunnel syndrome in pregnant
women often go away after childbirth. Unless your symptoms are very bad, you
may want to wait and see if your symptoms go away after you have the baby.
FAQs What is carpal tunnel syndrome?Carpal tunnel syndrome is a nerve problem that causes tingling, numbness, weakness, or pain
in the fingers, thumb, or palm, and sometimes the forearm. These symptoms are
caused by pressure on a nerve (median nerve) in the wrist (carpal tunnel). This problem is often linked
to hand and wrist motions that you do a lot. These are called repetitive
motions. Swelling or fluid retention in the wrist-which can happen during pregnancy
or because of a health problem-also can cause carpal tunnel symptoms or make
them worse. What problems can you have from carpal tunnel syndrome? Severe carpal tunnel syndrome that lasts a long time can lead to
permanent damage to the
median nerve. This can make it hard for you to use
your hand. You may have: - Pain.
- Weak thumb muscles. This
makes it hard for you to grip or hold objects.
- Loss of feeling and
ability to use your fingers and hand well.
How does surgery fix carpal tunnel syndrome?
Surgery reduces the pressure on the median nerve in the wrist. The doctor cuts
a ligament to relieve the pressure on the nerve. The surgery is
called carpal tunnel release . It can be done in one of two
ways: - Open surgery : Your doctor makes a small cut (incision) in the palm of
your hand.
- Endoscopic surgery : Your doctor makes one small incision in the wrist, or
one small incision in the wrist and one in the palm. He or she puts a thin tube with a camera attached (endoscope) into the incision. Surgical tools are put in
along with the scope.
You may decide to have surgery if
you've had very bad symptoms for a long time and other treatments haven't
helped. Sometimes surgery is needed to prevent lasting nerve
damage. You will likely have a
nerve test to see if you need surgery. How well does surgery work?Most people who have
surgery for carpal tunnel syndrome have less or no pain and numbness in their
hand and better hand function after surgery.1 It's not clear how long you should try nonsurgical treatment before considering surgery. But after people who have severe carpal tunnel syndrome have surgery, they typically have fewer symptoms and better hand function than people who continue using wrist splints or a combination of medicine and hand therapy.2 Both types of
surgery-open and
endoscopic-work equally well to improve
symptoms.3 Talk to your doctor about which surgery
might be best for you. Major problems from surgery can happen, but
they are rare. About 1 person out of 100 has a major problem after surgery,
such as nerve damage, while 99 out of 100 people don't.3 What can you do other than have surgery?You can
try several home treatments to help relieve your symptoms. This may be all you
need to do for mild symptoms of carpal tunnel syndrome. Doctors suggest that
you try these treatments for 3 to 12 months before you think about having
surgery. It often helps to try several treatments at the same time. You may try to: - Rest your hand for 1 or 2 weeks.
Stop activities that hurt.
- Put ice on the
palm of your hand and wrist for 10 to 15 minutes at a time.
- Take
nonsteroidal anti-inflammatory drugs (NSAIDs), such as
naproxen or ibuprofen. Studies
haven't shown NSAIDs to be effective for carpal tunnel syndrome, but they may help
relieve your symptoms. Talk to your doctor before taking
NSAIDs. They can cause side effects. Be safe with medicines. Read and follow all instructions on the label.
- Change the way you do certain hand motions.
- Wear a
wrist splint. It's usually worn at night, but you can
wear it during the day.
Other choices - You can work with a
physical therapist to learn how to do activities in a
new way.
- If these home care treatments don't help, you may be able
to take
corticosteroid shots or pills to improve your
symptoms.
- You can try
yoga.
- Symptoms of carpal tunnel syndrome
in pregnant women often go away after childbirth. Unless your symptoms are very
bad, you may want to put off having surgery and see if your symptoms go away
after you have the baby.
How well do other treatments help symptoms?Rest,
ice, and other home treatments may be all you need if you've had
mild symptoms for a short time. Your doctor may also suggest that you try wrist splints or corticosteroids to avoid or delay surgery. - Splints are easy and inexpensive, and there is little risk to trying them.
- Corticosteroid shots and pills give short-term relief from
symptoms.4
Why might your doctor recommend surgery for carpal tunnel syndrome?Your doctor might recommend surgery if: - You've had very bad symptoms for a long time,
so you're at risk of having lasting nerve damage.
- Test show that
you have nerve damage.
- A wrist splint, medicines, and other
treatments haven't helped your symptoms.
2. Compare your options| | Have surgery for carpal
tunnel syndrome | Try other treatments
|
|---|
| What is usually involved? | - You have
local anesthetic, so you are awake but won't have
pain.
- You go home on the same day.
- You need to avoid heavy use of your hand
for up to 3 months.
- If you have open surgery on your dominant hand and you do repeated actions at work, you may be able to return to work in 6 to 8 weeks. If the surgery is on the other hand and you do not do repeated actions at work, you may be able to return to work in 7 to 14 days. If you have endoscopic surgery, you may be able to return to work sooner than with open surgery.
| - You can try several home
treatments to ease symptoms of carpal tunnel syndrome, including:
- Rest.
- Ice.
- A
wrist splint.
- New ways of doing
tasks.
- Yoga.
- You may get
corticosteroids.
- If you are
pregnant, you can wait to see if the problem goes away after childbirth.
|
|---|
| What are the benefits? | - Surgery can make symptoms get
better or go away for most people.
- It can prevent lasting nerve damage.
| - You don't have the risks of
surgery.
- You may not have to take time off from work.
- You don't have the expense of surgery.
|
|---|
| What are the risks and side effects? | - Surgery doesn't
always help.
- Your symptoms may come
back.
- Major problems from surgery, such as infection or a problem from
anesthesia, are rare.
| - Other treatments
might not work.
- If you have very bad symptoms and wait too long, you could have
lasting nerve damage.
- Temporary increase in pain, or a small chance of nerve damage, after a corticosteroid shot.
|
|---|
Personal storiesPersonal stories about surgery for carpal tunnel syndrome
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"One of the most annoying things about my carpal tunnel syndrome is the night pain in my hands. If I don't wear the splints, it wakes me up almost every night. But with the splints, I can get a good night's sleep, and my doctor says that my thumb and hand strength are not too bad. I'm nervous about any kind of surgery, so when my doctor said it would be okay to wait awhile, I said, "Great." If the splints stop working, though, I'll probably be back in my doctor's office!" "I own a landscaping business, and a few months ago I started having a lot of pain when putting in backyard fences. Then the pain started to wake me up at night and keep me awake. My doctor said I had a classic case of carpal tunnel syndrome. I tried some of the home treatments that she recommended, and the problem didn't get any worse, but it didn't get any better, either. So I went back and asked about surgery. It sounds like the surgery has a good chance of taking care of the problem, so I'm going to give it a try. When you own your own company, it's too expensive to keep missing work. But I'll have to wait till the slow season, because I'll have to take a few weeks' break to recover." "I thought for sure that I was going to have to have surgery for my carpal tunnel. I'm an order-taker for a mail-order catalog company, which means I type a lot, and my symptoms were really getting bad. My fingers were numb, so I kept hitting the wrong keys on the keyboard and making errors. The pain was waking me up at night, and it was even starting to hurt during the day. I went to my boss and the human resources manager at work, and together we worked out a job-sharing arrangement that lets me take orders for part of the day and work in the mail room the rest of the day. I am going to see how that helps, along with the exercises and the splints." "When I dropped my third coffee cup in a week, I decided it was time to do something about my hands. I've had this carpal tunnel problem for a couple of years now, and I'm tired of wearing the splints and getting occasional steroid shots in my wrists. My doctor says that whether I have surgery or not is really up to me at this point. I think I'm ready for it." 3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery Reasons not to have surgery I tried other treatments, but my pain is still bad. I can live with the pain while I give other treatments some more time to work. More important Equally important More important I don't mind having surgery if it can get rid of my symptoms. I just don't want to have surgery. More important Equally important More important I'm not worried about the small chance of problems from surgery. I don't want to take even a small chance of something going wrong with surgery. More important Equally important More important I'm afraid of having lasting nerve damage from carpal tunnel syndrome. I'm not worried that I'll have lasting nerve damage from carpal tunnel syndrome. More important Equally important More important My other important reasons: My other important reasons: More important Equally important More important 4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having surgery NOT having surgery Leaning toward Undecided Leaning toward 5. What else do you need to make your decision?
Check the facts
1.
Home treatments may be all I need to get rid of mild symptoms from carpal tunnel syndrome. That's right. Home treatments often work for mild symptoms from carpal tunnel syndrome. You can try rest, ice, and doing tasks in a new way. 2.
Surgery may not be a good choice if my symptoms are caused by pregnancy or a health problem. That's right. Symptoms often go away after childbirth or after treatment for the health problem. 3.
I have a good chance of improving or getting rid of my symptoms with surgery. That's right. Surgery is likely to improve or get rid of your symptoms. But it doesn't work all the time. Decide what's next1.
Do you understand the options available to you? 2.
Are you clear about which benefits and side effects matter most to you? 3.
Do you have enough support and advice from others to make a choice? Certainty1.
How sure do you feel right now about your decision? Not sure at all Somewhat sure Very sure 2.
Check what you need to do before you make this decision. Credits | By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | Herbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery |
|---|
References Citations - Ashworth NL (2014). Carpal tunnel. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1114/overview.html. Accessed October 2, 2014.
- Huisstede BM, et al. (2010). Carpal tunnel syndrome. Part II: Effectiveness of surgical treatments-A systematic review. Archives of Physical Medicine and Rehabilitation, 91(7): 1005-1024.
- Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).
- Piazzini DB, et al. (2007). A systematic review of the conservative treatment of carpal tunnel syndrome. Clinical Rehabilitation, 21(4): 299-213.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.Current as of:
March 21, 2017 Ashworth NL (2014). Carpal tunnel. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/1114/overview.html. Accessed October 2, 2014. Huisstede BM, et al. (2010). Carpal tunnel syndrome. Part II: Effectiveness of surgical treatments-A systematic review. Archives of Physical Medicine and Rehabilitation, 91(7): 1005-1024. Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4). Piazzini DB, et al. (2007). A systematic review of the conservative treatment of carpal tunnel syndrome. Clinical Rehabilitation, 21(4): 299-213. Last modified on: 8 September 2017
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