Carpal Tunnel Syndrome - Surgery

Surgery

Carpal tunnel release surgery is among the most common surgeries performed in the United States. In various trials, 70 - 90% of patients who underwent surgery were free from nighttime pain afterward. Studies have found that surgery provides a greater benefit over the long term compared with splinting or anti-inflammatory drugs plus hand therapy.

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 to have surgery to correct CTS, and when to have it, is not always clear. Electrodiagnostic and other tests used to confirm CTS are not always perfect or useful in determining the best candidates for surgery.

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As a result, surgery does not cure all patients. A number of experts believe that release surgery is performed too often. Some recommend a full trial of conservative treatment (such as splints, anti-inflammatory agents, and physical therapy) before choosing surgery. Others warn that CTS is often progressive and will worsen over time without surgery, and that surgery is better than splints and conservative measures for pain relief in cases where carpal tunnel syndrome is likely present.

Factors that may increase the chances of successful surgery:

• Having surgery performed within 3 years of being diagnosed with the disorder
• Being in good general health
• Having very slow nerve conduction results, but also having reasonably good muscle strength before surgery
• Having symptoms that are worse at night than during the day

Factors that may reduce the chances for success:

• Having very severe symptoms before surgery, such as:
  • Continual numbness
  • Muscle weakness and wasting
  • Very poor nerve conduction results
• Symptoms that have been present for more than 10 months
• Being over 50 years old
• Performing heavy manual labor, particularly working with vibrating tools. Only slightly more than half of people who use vibrating hand-held tools are symptom-free 3 years after a CTS operation.
• Patients who are on hemodialysis have good initial success, but the condition deteriorates in about half of these patients after around a year and a half.
• Poor mental health or alcohol abuse
• Patients with diabetes and high blood pressure may be more likely to require a second operation.