It can start as that vague aching in your wrist, tingling or numbness in your fingers or hand. Then one day you feel a pain radiating from your wrist up your arm to your shoulder, and your hands feel weak  to the point that you even start dropping things. These are all symptoms of carpel tunnel syndrome, a pinching of the median nerve as it passes through the "carpal tunnel" at the palm side of the wrist. The signs and symptoms of carpal tunnel syndrome may be mild, moderate, or severe and usually worsen without treatment. But is surgery the answer? 

Carpal tunnel syndrome often affects people who do repetitive tasks with their hands, fingers or wrists such as working with tools, heavy machinery or now more commonly, with computers. The repetitive motion can cause pressure on the median nerve, which results in the numbness, pain and hand weakness characterized with carpal tunnel syndrome.

Your decision about whether to have surgery for carpal tunnel syndrome should involve several considerations, including the severity and duration of your condition, the risks of not treating chronic carpal tunnel syndrome, and the risks of having surgery.

Consider the following when making your decision.

Non-surgical Treatments

According to the Mayo Clinic, most people with carpal tunnel syndrome experience effective treatment with non-surgical methods, including:

  • Wrist splinting. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Splinting is more likely to help you if you've had only mild to moderate symptoms for less than 10 months.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as Ibuprofen (Advil, Motrin, and others) and naxoproxen (Alev), may help relieve pain from carpal tunnel syndrome if you have an associated inflammatory condition.
  • Corticosteroids. Your doctor may inject your carpal tunnel with a corticosteroid, such as cortisone, to relieve your pain. Corticosteroids decrease inflammation, which relieves pressure on the median nerve.

Additionally, carpal tunnel syndrome can be treated non-surgically by using a combination of rest, ice, stretching, strengthening, healthier body mechanics when doing manual tasks, and working with your doctor to manage other health conditions that may be contributing to carpal tunnel syndrome.

Surgical Treatment

While non-surgical treatments may be the best option for you if you have mild nerve impairment, surgery may need to be considered if your carpal tunnel symptoms are severe and persist more than six months. 

The surgery used to relieve carpal tunnel syndrome symptoms is called carpal tunnel release. The procedure involves cutting the transverse carpal ligament to relieve pressure on the median nerve in the wrist. In other words, the goal of surgery is to reduce the pressure on the median nerve.

According to a 2002 study published in the New England Journal of Medicine, more than 70 out of 100 people who have surgery for carpal tunnel syndrome are satisfied with their results, and as many as 90 out of 100 people have no night pain after surgery.

While surgery usually results in marked improvement, you may experience some residual numbness, pain, stiffness or weakness in your wrists, hands and fingers. This may take several weeks to as long as a few months to resolve.

Some other factors to consider:

  • Surgery may only provide partial relief when another medical condition, such as rheumatoid arthritis, obesity, or diabetes, is contributing to carpal tunnel syndrome.
  • Unless carpal tunnel symptoms become intolerable, a pregnant woman should delay surgery until after childbirth. After delivery, symptoms often disappear without treatment when pregnancy-related fluid buildup is relieved.

Final Considerations

If surgery appears to be the best option for relieving your carpal tunnel symptoms, talk with your doctor about the procedure that will work best for you in relation to your activity levels, both at work and at home. Be sure also to discuss a rehabilitation plan.

Note: If you leave carpal tunnel syndrome untreated, nerve and muscle damage can occur. If you have persistent signs and symptoms of carpal tunnel syndrome, call your doctor to discuss a treatment plan.

Sources

Carpal Tunnel Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm. Accessed February 8, 2010.

Carpal Tunnel Syndrome. The Center for Orthopedics and Sports Medicine. http://www.arthroscopy.com/sp04004.htm. Accessed February 8, 2010.

Erstad, Shannon. Open Carpal Tunnel Surgery for Carpal Tunnel Syndrome. WebMd.com. http://www.webmd.com/pain-management/carpal-tunnel/open-carpal-tunnel-surgery-for-carpal-tunnel-syndrome. Accessed February 8, 2010.

Katz JM, Simmons BP (2002). Carpal tunnel syndrome. New England Journal of Medicine, 346(23): 1807-1812.

Mayo Clinic Staff. Carpal Tunnel Syndrome. MayoClinic.com. http://www.mayoclinic.com/health/carpal-tunnel-syndrome/DS00326. Accessed February 8. 2010.