When is surgery considered or needed?

Photo of a patient at the hospital (PantherMedia / Lilyana Vynogradova)

Most people with carpal tunnel syndrome only consider having surgery if other treatments don't provide enough relief. Surgery can help relieve symptoms or make them go away for good, but it is not without risks.

In carpal tunnel syndrome the median nerve, which runs through the carpal tunnel in your wrist, is squashed. This can cause pain, tingling and numbness, and affect certain hand movements. Surgical treatment involves cutting a fibrous band on the inside of the wrist, known as the flexor retinaculum. The aim is to reduce pressure on the median nerve. This is one of the most commonly performed surgical procedures in Germany.

Although surgery sometimes makes the symptoms go away for good, it's not always necessary. Other treatments are usually preferred, especially if the condition is still in an early stage. Urgent surgery is usually only needed for treating a very uncommon condition called acute carpal tunnel syndrome.

There are two possible surgical procedures:

  • Open carpal tunnel release: The surgeon makes a cut on the inside of the wrist, and then cuts right through the flexor retinaculum.
  • Endoscopic carpal tunnel release: Here the surgeon has to make a cut on your palm and your wrist. They insert a very small camera (called an “endoscope”) through one of the cuts to monitor the procedure, and guide an instrument through the second cut to then cut right through the flexor retinaculum. Another endoscopic technique involves using just one small cut in the wrist.

These two approaches 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.

The surgery is typically done at a day clinic but can also be performed in a hospital. Usually only a local anesthetic is needed to numb the hand or arm, but a brief regional or general anesthetic might also be used.

How effective is surgery?

Surgery is usually only considered if symptoms return regularly and problems associated with the painful sensations increase despite trying other treatments such as splints or corticosteroid injections. In those cases surgery can provide better relief than repeat injections or splint treatments.

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

Most people’s symptoms disappear after surgery: If you don't experience 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 damaged. It can take several weeks or months for more severe symptoms to go away completely. The pain usually improves pretty fast, but the abnormal sensations may need more time to disappear. So it might be preferable to not wait too long to have surgery.

But sometimes surgery doesn't provide enough relief. The symptoms may not go away, or come back afterwards. It is 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. About 75 to 90 out of 100 people report that their symptoms have improved or that they are symptom-free several years later. But this may have happened without having surgery too.

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 may have been wrong, so surgery was performed even though the symptoms were being caused by something else.
  • Symptoms may persist or worsen if there is a surgical error or the flexor retinaculum is not cut through completely.

What risks are associated with surgery?

You may experience bruising in your hand or temporary numbness after the procedure. That usually disappears after a few weeks. But other problems may occur that last longer, such as pain or trouble with the surgical scar. About 5 out of 100 people who have open surgery can expect to have 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. In these cases trouble moving the hand, pain and numbness might not go away.

The risk of complications also depends on how experienced the surgeons are. This is especially true for the endoscopic procedures – they are slightly more difficult.

What do you need to know after the operation?

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. Some doctors recommend keeping it still for a few days by wearing a splint, 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. Three weeks is usually enough if you don't put much strain on your wrist at your job. People who work with their hands a lot may need 4 to 5 weeks.