Many patients with carpal tunnel syndrome can be treated successfully without surgery. If the condition continues to get worse, however, non-operative treatment will no longer be effective. Symptoms over time can become harder to control, occur more frequently, and the numbness can become constant. Surgery is the best way to relieve the symptoms and prevent nerve deterioration. Show
Carpal tunnel release surgery is one of the most common procedures in orthopedic surgery. In many published studies, approximately 90% of surgical patients have a successful outcome and are satisfied with the procedure. Most of these patients would recommend the procedure to a friend or family member with the same condition. However, a small percentage of patients do not have a good result with carpal tunnel surgery. There are several important reasons why carpal tunnel release surgery may not work well:
Evaluating a patient with failed carpal tunnel release surgery is difficult, but all of these factors should be considered in the decision-making process. OverviewThe carpal tunnel is a space in the wrist that holds tendons and your median nerve. This space is compressed in carpal tunnel syndrome. One symptom of carpal tunnel syndrome is numbness that spreads throughout the hand (see shaded blue area).What is carpal tunnel syndrome?Carpal tunnel syndrome is a common condition that causes pain, numbness, tingling, and weakness in the hand and wrist. It happens when there is increased pressure within the wrist on a nerve called the median nerve. This nerve provides sensation to the thumb, index, and middle fingers, and to half of the ring finger. The small finger (the “pinky”) is typically not affected. Carpal tunnel syndrome was first described in the mid-1800s. The first surgery for the release of the carpal tunnel was done in the 1930s. It is a condition that has been well recognized by orthopaedic surgeons for over 40 years. What is the carpal tunnel?The carpal tunnel is a narrow canal or tube in the wrist. Similarly to a tunnel you could travel through by car, this part of the wrist allows the median nerve and tendons to connect the hand and forearm. The parts of this tunnel include:
Inside the tunnel are the median nerve and tendons.
Does carpal tunnel syndrome only happen to office workers or factory workers?No. Many people with carpal tunnel syndrome have never done office work or worked on an assembly line. It affects people who use their wrists and hands repeatedly at work and at play. Anyone can get carpel tunnel syndrome, but it is unusual before age 20. The chance of getting carpal tunnel syndrome increases with age. Who is at risk for carpal tunnel syndrome?People at risk for carpal tunnel syndrome are those who do activities or jobs that involve repetitive finger use. Motions that can place people at risk of developing carpal tunnel syndrome include:
Many other factors can also contribute to the development of carpal tunnel syndrome. These factors can include:
Carpal tunnel syndrome is also more common in women than in men. Symptoms and CausesWhat causes carpal tunnel syndrome?Carpal tunnel syndrome is caused when the space (the carpal tunnel) in the wrist narrows. This presses down on the median nerve and tendons (located inside the carpal tunnel), makes them swell, which cuts off sensation in the fingers and hand. How often is hand pain caused by carpal tunnel syndrome?While carpal tunnel syndrome is a common condition, it has a different set of symptoms from many other sources of hand pain. There are actually several similar conditions that cause hand pain. These include:
What are the symptoms of carpal tunnel syndrome?Symptoms usually begin slowly and can occur at any time. Early symptoms include:
In fact, because some people sleep with their wrists curled, nighttime symptoms are common and can wake people from sleep. These nighttime symptoms are often the first reported symptoms. Shaking the hands helps relieve symptoms in the early stage of the condition. Common daytime symptoms can include:
As carpal tunnel syndrome worsens, symptoms become more constant. These symptoms can include:
In the most severe condition, the muscles at the base of the thumb visibly shrink in size (atrophy). Diagnosis and TestsHow is carpal tunnel syndrome diagnosed?First, your doctor will discuss your symptoms, medical history and examine you. Next, tests are performed, which may include:
Management and TreatmentHow is carpal tunnel syndrome treated?Carpal tunnel syndrome can be treated in two ways: non-surgically or with surgery. There are pros and cons to both approaches. Typically, non-surgical treatments are used for less severe cases and allow you to continue with daily activities without interruption. Surgical treatments can help in more severe cases and have very positive outcomes. Non-surgical treatments Non-surgical treatments are usually tried first. Treatment begins by:
Other treatments focus on ways to change your environment to decrease symptoms. This is often seen in the workplace, where you can make modifications to help with carpal tunnel. These changes might include:
Surgical treatments Surgery is recommended when carpal tunnel syndrome does not respond to non-surgical treatments or has already become severe. The goal of surgery is to increase the size of the tunnel in order to decrease the pressure on the nerves and tendons that pass through the space. This is done by cutting (releasing) the ligament that covers the carpal tunnel at the base of the palm. This ligament is called the transverse carpal ligament. If you have surgery, you can expect to:
PreventionHow can carpal tunnel syndrome be prevented?Carpal tunnel syndrome can be difficult to prevent. The condition can be caused by so many different activities in a person’s daily life that prevention can be challenging. Workstation changes—proper seating, hand and wrist placement—can help decrease some factors that can lead to carpal tunnel syndrome. Other preventative methods include:
Outlook / PrognosisDoes carpal tunnel syndrome have a long recovery?Surgery to repair carpal tunnel syndrome does not have a particularly long recovery. The bandage that covers the stitches after surgery can be removed in a few days. The hand can then be used for light activities. Making a fist is encouraged. Full range of finger motion and early symptom relief is usually seen within two weeks after the stitches have been removed. You can usually return to most activities by six weeks. Your return to work depends on factors such as type of work, how much control you have over your work and workplace equipment. What is the success rate for carpal tunnel syndrome surgery?Surgery for carpal tunnel syndrome has a very high success rate of over 90%. Many symptoms are relieved quickly after treatment, including tingling sensation in the hands and waking up at night. Numbness may take longer to be relieved, even up to three months. Surgery won’t help if carpal tunnel syndrome is the wrong diagnosis. When the carpal tunnel syndrome has become severe, relief may not be complete. There may be some pain in the palm around the incisions that can last up to a few months. Other after-surgery pain may not be related to carpal tunnel syndrome. Patients who complain of pain or whose symptoms remain unchanged after surgery either had severe carpal tunnel syndrome, had a nerve that was not completely released during surgery, or did not really have carpal tunnel syndrome. Only a small percentage of patients do not gain substantial relief from symptoms. How often does carpal tunnel surgery fail?Carpal tunnel release (CTR) is the commonest procedure performed by hand surgeons. Complications and failures have been reported to occur in 3-25% of cases, with up to 12% needing re-exploration.
Is there a downside to carpal tunnel surgery?Other potential risks of a carpal tunnel release surgery include: Bleeding. Infection. Injury to the median nerve or nerves that branch out from it.
What happens if carpal tunnel surgery is not successful?Failed carpal tunnel surgery can present as deterioration, recurrence or persistence of symptoms after surgical decompression. The causes of failed carpal tunnel decompression can often be categorised into four groups; poor surgery, poor nerve, poor diagnosis or poor luck.
Is carpal tunnel surgery worth having?Many people wonder if carpal tunnel surgery is worth it. The answer is yes. About 70-90% of patients who undergo carpal tunnel surgery are satisfied with the results. A very small group of patients who have the surgery do not experience total relief from symptoms.
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