6 things to know about carpal tunnel surgery

By Benjamin Welling, MD

Carpal tunnel syndrome — a condition where the median nerve in the wrist is compressed, causing numbness and tingling — can be frustrating and painful, especially when it interferes with daily tasks like typing, cooking or even holding a phone.

If you’re considering surgery, you might have questions. Here are six key things to know about carpal tunnel syndrome and carpal tunnel release surgery.

1. It’s successful

The surgery for carpal tunnel syndrome is wonderfully successful. Studies have been done analyzing the rates of success of all types of surgery. The three surgeries that have come out on top are hip replacement, cataract surgery and carpal tunnel surgery.

Patients generally do very well and are very happy after carpal tunnel surgery. It’s one of the surgeries I see with the least amount of complications and the highest rates of satisfaction.

2. Carpal tunnel syndrome is not exclusively a work hazard

One of the misconceptions I encounter a lot is that people think carpal tunnel syndrome is an occupational hazard. While some people with the syndrome spend a lot of their workday typing or doing manual labor, data shows it’s actually disconnected from occupation.

Carpal tunnel either has an unknown cause or is due to systemic causes of inflammation, like diabetes, diet or an autoimmune disease.

3. Nonsurgical treatments are available for mild cases

Nonsurgical treatments play a role when carpal tunnel syndrome is mild. In these cases, we start with bracing and steroid injections.

If symptoms are moderate to severe or there is permanent numbness or weakness, we will proceed straight to surgery to preserve long-term function and use of the nerve. If nerve compression is left untreated, the long-term outcome is worse.

4. There are several types of surgeries for carpal tunnel

Twenty to 30 years ago, we only did open procedures. Now, those are one of three available surgeries. The other two are mini open and endoscopic carpal tunnel release.

In a mini open, a small, 2-3-centimeter incision is made within the palm. In endoscopic release, a tiny camera is inserted to guide the surgeon.

In the long term, all three surgeries are equally successful. The type of release is largely dictated by what the surgeon is comfortable with. I personally perform a lot of the mini open procedures.

5. Symptoms in the wrist may not always be carpal tunnel

Carpal tunnel syndrome is nerve compression within the wrist. Sometimes, however, a person with wrist symptoms may actually have nerve compression in the neck or elbow.

We will often start with a steroid injection to help with symptoms, but it’s also beneficial for diagnostic clarity. If I give a patient a steroid shot and we see dramatic improvement, even if the symptoms come back, this indicates the surgery would likely be successful.

If there is no improvement, the nerve compression may be in the neck. At that point, we might do an MRI of the neck and move their care to our cervical spine experts.

6. Recovery is usually smooth, but varies by person

You should expect soreness for about 10 weeks. Some of my patients are surprised at how fast symptoms get better, while others feel that 10 weeks is longer than they expect.

There is usually soreness within the heel of the palm. Deep tissue massage of the area can help.

Grip strength declines immediately after surgery, but then it slowly builds, and by 10 weeks after surgery it surpasses the person’s presurgery strength.