Surgery

Every year over 200,000 people in the US undergo surgeries for carpal tunnel syndrome, rendering them among the most common surgical procedures performed on the hand. In various trials, 70 - 90% of patients who underwent surgery were free of nighttime pain afterward.

Candidates for Surgery

Although evidence strongly suggests that surgery is more effective than conservative approaches (at least in patients with moderate to severe CTS), the decision about whether and when to have surgery to correct CTS is a troubling one for patients. Electrodiagnostic and other tests used to confirm the presence of CTS are not very useful in determining the best candidates for surgery. For example, results suggesting severe CTS may not relate at all to surgical success or the lack of it.

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In general, patients with the following findings are less likely to respond to conservative therapy and, therefore, might benefit from surgery:

• Older than 50 years.
• Symptoms lasting 10 months or longer.
• Continual numbness.
• The muscles in the base of the palm have begun to atrophy (shrink)
• Symptoms occur within 30 seconds during a Phalen's test.

According to a 2002 study, if none of these factors are present, conservative therapies (splinting and anti-inflammatory agents) are effective in two thirds of patients. However, the conservative approach was ineffective in 60% of patients if only one of these factors were present, in 83% with only two of them, and in virtually all patients who had three or more.

Surgery does not cure all patients, and because it permanently cuts the carpal ligament, some wrist strength is often lost. A number of experts believe that release surgery is performed too often. They recommend aggressive conservative treatment (such as splints, anti-inflammatory agents, and physical therapy) before choosing the more invasive option.