When is surgery considered or needed?

There are two possible surgical procedures:

• Open carpal tunnel release: The surgeon cuts open the skin on the inside of the wrist, and then cuts right through the transverse carpal ligament.
• Endoscopic carpal tunnel release: Here the surgeon makes two small cuts: one on your palm and one on your wrist. A tube with a small camera at the end ( endoscope) is inserted through one of the cuts in order to monitor the procedure. An instrument is inserted through the second cut to then cut right through the transverse carpal ligament. Another endoscopic technique involves using just one small cut in the wrist.

Open surgery and endoscopic surgery are equally good at relieving symptoms and associated with similar risks. Recovery times may be a little shorter after endoscopic procedures, allowing people to return to work sooner.

This procedure is usually done as day surgery, but it can also be done in a hospital. Usually only a local anesthetic is needed to numb the hand or arm. A brief regional or general anesthetic is sometimes used, though.

Surgery is usually only considered if symptoms return regularly despite trying out other treatments such as splints and steroid injections, and if problems due to the painful abnormal sensations get worse. In those cases, surgery can provide better relief than repeat injections or splint treatments can.

Most people’s symptoms go away after surgery: If you haven't experienced any lasting abnormal sensations or loss of strength in the wrist, the symptoms usually improve rapidly. One of the things that determines how fast you recover is how badly the nerve was already damaged. It can take several weeks or months for more severe symptoms to go away completely, particularly if the symptoms were severe. The pain usually improves pretty fast, but the abnormal sensations may need more time to disappear. So it might be a good idea to not wait too long to have surgery. Even several years after surgery, about 75 to 90 out of 100 people still have no symptoms or at least fewer symptoms than before.

Acute carpal tunnel syndrome with sudden and severe pain is quite rare. It most often occurs after an injury, inflammation or bleeding in the wrist. Having surgery quickly is then often the only effective treatment.

Sometimes surgery doesn't provide as much relief as expected. The symptoms may not go away, or they might come back afterwards. It's difficult to predict how effective surgery will be. This may depend on things like how long you have had symptoms and how severe they are, or whether you have other illnesses. The chances of success are higher if the condition is in an earlier stage.

If the surgical procedure doesn't have the desired outcome, there are a number of possible explanations:

• The condition might already be at such an advanced stage that surgery can no longer make the symptoms go away completely.
• The diagnosis was not correct. That means that the surgery was performed although something else was causing the symptoms.
• If a mistake was made during surgery or the transverse carpal ligament wasn't cut through completely. The symptoms may then persist or get worse.

If you still have severe symptoms even after surgery, it's a good idea to be examined by a doctor again. More surgery may then be considered.

You may experience bruising in your hand or temporary numbness after the procedure. That usually disappears after a few weeks. But longer-lasting problems may arise as well, such as pain.

Pain along the surgical scar is more common in open carpal tunnel release surgery, while nerve damage is more common in endoscopic carpal tunnel release surgery. About 5 out of 100 people who have open carpal tunnel release surgery develop these kinds of minor complications, compared to about 3 out of 100 people who have endoscopic surgery.

Fewer than 1 out of 100 people have more major complications following surgery. Examples of such complications include a swollen hand or median nerve damage. They can result in lasting movement problems, pain and numbness.

The risk of complications also depends on how experienced the surgeons are. This is especially true for the endoscopic procedures, which are slightly more difficult to do.

Your wrist is wrapped in a bandage after surgery. The stitches are removed after about two weeks. There are differing opinions on how long you need to rest your hand after having surgery. Some doctors recommend keeping it in a splint for a few days to prevent it from moving, but there is no scientific evidence that this helps. So there is usually nothing wrong with moving your hand the day after surgery and putting a little strain on it.

Heavy lifting and major strain should be avoided for several weeks to give the wound a chance to heal properly. The type of work you do will determine how early you can return to work. If you don't have to put much strain on your wrist at your job, about three weeks is usually enough. People who do more manual work may need to wait four to five weeks.