Carpal Tunnel Syndrome: Surgical and Nonsurgical Treatment 

By Author : Dr. Deepanshu Siwach
  calender 13 January,2025
Carpal Tunnel Syndrome: Surgical and Nonsurgical Treatment 

Imagine this: you're typing away at your desk, scrolling through your phone, or simply enjoying a cup of coffee when suddenly, bam—that familiar tingling, numbness, or sharp pain in your wrist strikes again. For nearly 10 million people in India every year, this is the reality of carpal tunnel syndrome (CTS), a condition that makes everyday tasks feel like a workout for your hands. But fear not—thanks to carpal tunnel release surgery, there's a solution that offers significant relief for many sufferers.

So, whether you're typing on your laptop or gripping your favorite mug, let's explore everything you need to know about carpal tunnel surgery and how it can get your wrists back in action without pain!

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome, abbreviated as CTS, is a condition affecting the wrist and hand. CTS results from the median nerve compression as it passes through the carpal tunnel—a narrow corridor in the wrist made up of ligaments and bones. Median nerve gives sensation to the thumb, middle, index, and part of the ring finger. It also controls some muscles at the base of your thumb. When it's pinched, you can experience pain, numbness, and weakness in your hand.

Carpal tunnel syndrome can develop slowly or arise suddenly due to certain activities or health conditions. It's important to recognize the symptoms early to seek appropriate treatment and stop the condition from worsening.

What are the Signs and Symptoms of Carpal Tunnel Syndrome?

  • Carpal tunnel syndrome often starts with tingling or numbness in the thumb, index, middle, and ring fingers. The little finger is usually not affected. The tingling may feel like pins and needles or that your fingers have fallen asleep. These sensations are often worse at night and can wake you up.
  • Another common symptom is pain in the wrist, palm, or forearm. It may feel sharp, like a burning stab or a persistent ache deep inside the hand. Some people also feel like their fingers are swollen, even with no visible swelling.
  • As CTS progresses, weakness in the hand can develop. It is hard to grip objects or perform precise tasks like buttoning a shirt or typing. Symptoms can worsen after repetitive activities like typing, knitting, or using tools. Over time, numbness and pain may also occur during the day.
  • In more severe cases, CTS can cause chronic pain and permanent numbness. Some people notice their hands feel clumsy or weak, making it hard to hold objects like a mug or a pen. Many find themselves shaking their hands as if trying to fling off water to relieve the discomfort. Without treatment, nerve damage and loss of hand function may occur. Early diagnosis and care are crucial.
  • If left untreated, symptoms can progress, leading to permanent nerve damage and/or loss of hand function.

What are the Causes and Risk Factors of Carpal Tunnel Syndrome?

Carpal tunnel syndrome occurs when extra pressure is added to the median nerve in the wrist. The carpal tunnel has limited space, and any swelling or damage can press on the nerve, leading to CTS. Multiple factors contribute to this condition. Common causes of carpal tunnel syndrome are:

  • Repetitive Hand Movements: Activities like typing, writing, or using vibrating tools strain the wrist over time. Repeated motions or extreme wrist positions can lead to tendon irritation and swelling.
  • Wrist Injuries and Anatomical Factors: Wrist fractures, dislocations, or arthritis can narrow the carpal tunnel. People with smaller carpal tunnels are more prone to CTS. These anatomical differences can run in families.
  • Health Conditions: Chronic illnesses like diabetes can damage the median nerve, increasing the risk of CTS. Inflammatory conditions (rheumatoid arthritis and gout) cause swelling that puts pressure on the nerve. Other conditions, like thyroid disorders, kidney failure, and amyloidosis, are also associated with CTS.
  • Hormonal and Body Fluid Changes: Pregnancy, menopause, and fluid retention can increase pressure within the carpal tunnel, irritating the median nerve. CTS related to pregnancy often resolves after delivery.
  • Obesity: Being obese is a major risk factor due to increased inflammation and swelling.
  • Medications: Some medications, such as anastrozole (used for breast cancer treatment), have been linked to carpal tunnel syndrome.
  • Workplace Factors: Jobs that involve repetitive wrist motions, vibrating tools (e.g., jackhammers), or assembly line work increase the risk of CTS. Work done in cold environments may worsen nerve damage.
  • Sex Assigned at Birth: CTS is more common in individuals assigned female at birth. It may be due to smaller carpal tunnels or hormonal influences on tendon linings.

Risk Factors for Carpal Tunnel Syndrome

Additional risk factors for carpal tunnel syndrome include:

  • Age: Adults over 40 are at higher risk.
  • Genetics: Family history plays a role, as anatomical traits like smaller carpal tunnels can be inherited.
  • Occupational Activities: Jobs requiring repetitive wrist motions or prolonged use of tools increase the likelihood of developing CTS. Studies suggest mouse use may be related to CTS, though the evidence linking keyboard use is inconsistent.
  • Medical Conditions: Conditions such as rheumatoid arthritis, hypothyroidism, gout, obesity, and amyloidosis increase the risk.
  • Environmental and Lifestyle Factors: Cold environments and repetitive stress without adequate rest contribute to nerve irritation and swelling.

While carpal tunnel syndrome has many causes and risk factors, not all are direct. Activities, anatomical predispositions, and medical conditions can combine to create pressure on the median nerve. Recognizing these risks and making adjustments—such as ergonomic improvements, reducing repetitive strain, and managing underlying health conditions—can help prevent or alleviate symptoms.

How is Carpal Tunnel Syndrome Diagnosed?

Carpal tunnel syndrome is diagnosed using a combination of physical examination, medical history, and imaging tests. These methods help determine the cause and severity of symptoms and rule out other conditions.

Medical History and Symptom Evaluation

  • Symptom Patterns: Doctors ask about when symptoms began and activities that worsen or relieve them.
  • Nighttime Symptoms: Waking up with numbness or tingling is a common indicator.
  • Specific Sensations: If the little finger is affected, another condition may be the cause, as the median nerve does not control sensation in that finger.

Physical Examination

Doctors perform several tests to assess wrist, hand, and finger function. Common physical examinations to check for carpal tunnel syndrome are:

  • Tinel's Sign: Tapping on the median nerve in the wrist. Tingling or numbness indicates CTS.
  • Phalen's Test: Holding the wrist in a flexed position for a minute to see if symptoms are triggered.
  • Sensation Tests: Checking fingertip sensitivity with a special instrument.
  • Strength and Muscle Check: Test thumb muscle strength and look for muscle atrophy at the thumb's base.

Diagnostic Tests

After taking a medical history and conducting physical examinations, orthopedics run several diagnostic tests to confirm the presence of carpal tunnel syndrome.

  • Electrodiagnostic Tests:
    • Nerve Conduction Studies (NCS): Electrodes measure how well the median nerve conducts signals. This test detects compression and assesses CTS severity.
    • Electromyography (EMG): A thin needle electrode measures electrical activity in muscles, identifying nerve or muscle damage.
  • Imaging Tests:
    • X-rays: Used to exclude other causes, such as fractures, arthritis, or ligament injuries.
    • Ultrasound: High-frequency sound waves create images of wrist tissues, showing nerve compression.
    • Magnetic Resonance Imaging (MRI): Provides detailed images of soft tissues to identify abnormalities like tumors, scarring, or other nerve issues.

What are the Nonsurgical Treatment Options for Carpal Tunnel Syndrome?

Non Surgical Treatment For Carpal Tunnel Syndrome

In early-stage carpal tunnel syndrome, nonsurgical methods can help relieve symptoms and slow progression. Common nonsurgical treatments are:

  • Wrist Splinting: Wearing a wrist splint or brace, especially at night, keeps the wrist in a neutral position. This reduces pressure on the median nerve and relieves nighttime tingling or numbness. Splints may also help during daytime activities that aggravate symptoms. Nighttime splinting is a good option for pregnant individuals since it avoids medications.
  • Medications: Nonsteroidal anti-inflammatory drugs, such as naproxen and ibuprofen, reduce inflammation and provide short-term pain relief. Injecting a corticosteroid, such as cortisone, directly into the carpal tunnel can decrease swelling and pressure on the median nerve. Injections often provide temporary relief but may not offer long-term benefits. Oral corticosteroids are generally less effective than injections.
  • Activity Modifications: Adjusting tasks or workstations can help reduce wrist strain. Changes may include altering hand positions, improving posture, or modifying tools to minimize repetitive motions. Occupational therapists can provide guidance on ergonomic improvements.
  • Physical Therapy and Exercises: Hand and wrist exercises can strengthen surrounding muscles, improve flexibility, and enhance circulation. Nerve-gliding exercises may help the median nerve move freely within the carpal tunnel, reducing irritation. An orthopedic doctor or therapist should recommend these exercises.
  • Steroid and PRP Injections: Corticosteroids are powerful anti-inflammatory agents that alleviate pain and inflammation. Platelet-rich plasma (PRP) is derived from the patient's blood and injected into the carpal tunnel. Some studies suggest temporary benefits, but long-term efficacy is uncertain.
  • Lifestyle Adjustments: Avoiding prolonged hand and wrist positions, especially flexion or extension, can prevent worsening symptoms. Taking breaks from repetitive tasks and incorporating rest periods during activities like typing or knitting is essential.

Note: While nonsurgical methods can manage mild to moderate symptoms, they may not be effective if nerve compression is severe.

What is Carpal Tunnel Release Surgery?

Carpal tunnel release is a simple surgical procedure that helps relieve the pressure on the median nerve by trimming the transverse carpal ligament, which forms the roof of the carpal tunnel. Cutting of the ligament increases the size of the tunnel and reduces compression on the nerve. The surgery is highly effective, particularly for patients with severe or long-standing symptoms.

Why is Carpal Tunnel Surgery Needed?

Carpal tunnel surgery, aka carpal tunnel release, is recommended when nonsurgical treatments fail to provide relief or when symptoms indicate severe nerve damage. Here are the primary reasons why this procedure may be necessary:

  • Constant or Severe Numbness and Tingling: When symptoms persist despite nonsurgical treatments like splints, medications, or corticosteroid injections.
  • Chronic Pain: Discomfort that disrupts sleep, daily activities, or work and doesn't improve over time.
  • Muscle Weakness: Difficulty gripping, pinching, or performing manual tasks due to weakened hand muscles.
  • Muscle Wasting: Visible hand and wrist muscle shrinking caused by prolonged median nerve compression.
  • Ineffectiveness of Nonsurgical Treatments: Nonsurgical methods, such as anti-inflammatory medications, physical therapy, ergonomic changes, and steroid injections, are usually tried first. If these fail to alleviate symptoms, surgery is considered.
  • Nerve Damage Prevention: Electromyography and nerve conduction studies may reveal significant median nerve damage or delayed electrical signals. Surgery is often recommended to prevent irreversible damage.
  • Prolonged Compression: In severe cases, delaying treatment can lead to permanent loss of sensation and function in the hand.
  • Functional Interference: Symptoms that significantly affect your ability to perform daily tasks, work responsibilities, or maintain quality of life.
  • Thumb-Side Symptoms: Severe pain, numbness, or tingling predominantly affecting the thumb side of the hand, often indicating advanced CTS.

When Might Surgery Be Performed Sooner?

  • Severe Pinching of the Median Nerve: When nerve compression causes significant symptoms, or EMG testing confirms advanced CTS.
  • Visible Muscle Atrophy: Early surgery may be needed to prevent further muscle weakening.
  • Prolonged Symptoms: Cases where symptoms have lasted for months without improvement through nonsurgical approaches.

How To Prepare For Carpal Tunnel Surgery?

Preparation for carpal tunnel release surgery is important to ensure a successful procedure and recovery. Here's what to expect and how to get ready:

Medical Evaluation

  • Review Medical History: Discuss your medical history, current health conditions, and prior surgeries with your surgeon.
  • Medications: Inform your surgeon about all drugs, vitamins, herbs, or supplements you are taking, including over-the-counter medicines. Some medications, such as blood thinners (aspirin, ibuprofen, naproxen), may need to be stopped temporarily to reduce the risk of bleeding.
  • Pre-Surgery Tests: Depending on your health, your doctor may request blood tests or an electrocardiogram (ECG) to ensure you're fit for surgery.

Pre-Surgery Instructions

  • Fasting: If general anesthesia is used, the orthopedic surgeon will ask you to avoid eating and drinking for 10-12 hours before the procedure.
  • Smoking Cessation: If you smoke, try quitting before surgery. Smoking can slow down the healing process. Ask your doctor for resources to help you stop.
  • Illness Notification: Before the surgery, notify your surgeon if you develop any illness, such as a cold, fever, or flu. Such conditions could lead to a postponement for safety reasons.

Post-Surgery Planning

  • Going Back Home: Arrange for someone to drive you home after the surgery, as anesthesia may temporarily impair your driving ability.
  • Home Preparation: Set up your home for a comfortable recovery. Examples include:
    • Easy-to-open containers for food and beverages.
    • Loose, comfortable clothing that is easy to wear with minimal hand movement.
    • Placing regularly used items within easy reach to avoid unnecessary strain.
  • Help at Home: During the initial recovery period, plan to have someone assist you with household tasks and daily activities.

Day-of-Surgery Tips

  • Follow your surgeon's instructions about which medications to take on the morning of the procedure.
  • Wear comfortable clothing and avoid wearing jewelry, nail polish, or any kind of makeup on the day of surgery.

Preparing for carpal tunnel surgery involves open communication with your healthcare provider, following pre-operative guidelines, and organizing your home and support system for recovery. These steps can reduce complications and improve your overall surgical experience.

How is Carpal Tunnel Release Surgery Performed?

Carpal tunnel release surgery is mostly an outpatient surgery to relieve excess pressure on the median nerve. There are two primary surgical techniques: open surgery and endoscopic surgery, along with a less common ultrasound-guided approach.

  • Open Carpal Tunnel Release is a simple procedure with fewer complications. It is a traditional technique that allows for direct visualization of the carpal tunnel and ensures clear identification of structures. The procedure involves the following steps:
    • The surgeon makes a 2-3 cm incision in the palm near the wrist.
    • The transverse carpal ligament is cut to enlarge the carpal tunnel.
    • The incision is stitched, and the hand is bandaged or splinted to prevent movement.
  • Endoscopic Carpal Tunnel Release involves smaller incisions, resulting in less scarring and post-operative pain. Endoscopic techniques allow faster recovery and an earlier return to normal activities. The general steps involved in endoscopic carpal tunnel release are:
    • One or two small incisions (less than 1 cm) are made in the wrist or wrist and forearm.
    • The surgeon inserts a flexible tube with a tiny camera (endoscope) to visualize the transverse carpal ligament.
    • Specialized instruments are used to cut the ligament under camera guidance.
    • Incisions are closed with stitches, and the hand is bandaged or splinted.
  • Ultrasound-guided Carpal Tunnel Release is another minimally invasive way of treating carpal tunnel syndrome. It involves:
    • A small probe is positioned next to the median nerve using ultrasound guidance.
    • The transverse carpal ligament is cut using a small knife or braided wire inserted through a needle.

General Steps in Carpal Tunnel Release Surgery

  • Preparation:
    • Patients change into a hospital gown and sign a surgical consent form.
    • The hand and wrist are cleaned and sterilized.
    • Local anesthesia is administered to numb the hand and wrist, or light sedation may be provided.
  • Surgery:
    • The surgeon accesses the transverse carpal ligament through an incision or with guided instruments.
    • The transverse ligament is cut to relieve pressure on the median nerve, increasing the tunnel's size.
    • After cutting, the ligament will gradually grow back, leaving more space for the nerve.
  • Post-Surgery:
    • Incisions are stitched, and the hand is bandaged or placed in a splint.
    • Carpal tunnel release typically takes 20–30 minutes, depending on the technique used.
    • The patient is monitored briefly before being discharged home.

Comparing Open and Endoscopic Carpal Tunnel Release

Feature Open Surgery Endoscopic Surgery
Incision Size Larger (2–3 cm) Smaller (0.5–1 cm)
Recovery Time Longer Faster
Scar Sensitivity Higher Lower
Surgical Complexity Less complex Requires specialized training
Pain Post-Surgery Moderate Typically less
Visualization Direct Camera-guided

What Happens After a Carpal Tunnel Release Surgery?

Immediately after surgery, Your hand and wrist will be placed in a splint to provide support and minimize movement. Some pain, swelling, and stiffness are normal and can be managed with prescribed pain relievers. Your treating surgeon will advise you to elevate your hand above your heart to reduce swelling and promote healing.

Recovery Process

  • Initial Recovery (1-2 Weeks): A nurse will apply a bandage and place your wrist in a splint for the first 1-2 weeks. Early movement of your fingers is encouraged to prevent stiffness. Follow-up appointments will check your progress and remove the splint or stitches, if present.
  • Physical Therapy: Motion exercises or physical therapy may begin after the bandage or splint is removed. These exercises help restore mobility, strength, and functionality.
  • Activity Restrictions: Avoid heavy lifting, repetitive motions, or strenuous activities until your doctor clears you. Light hand use, such as driving or writing, can typically resume within a few days to weeks.
  • Pain Management: Mild soreness or stiffness can last several weeks to months. Over-the-counter (OTC) medications like acetaminophen or NSAIDs may help manage symptoms.
  • Long-Term Recovery: Grip and pinch strength usually return in 2-3 months, but it can take up to a year in severe cases. Numbness and tingling may improve over several months, depending on the severity of nerve damage before surgery. Complete recovery varies based on the individual and the severity of the condition.

Outcomes of Carpal Tunnel Release

  • Most patients experience relief from symptoms such as pain, numbness, and tingling soon after surgery.
  • Recovery may take longer if symptoms are severe or if there is significant nerve damage.
  • In rare cases, carpal tunnel syndrome can recur, requiring additional treatment.

Important Considerations

  • Follow-up: Your doctor will check your incision site and progress during follow-up visits, ensuring proper healing.
  • When to Seek Help: Contact your healthcare provider if you notice signs of infection (e.g., redness, swelling, fever, or discharge from the incision) or if the pain worsens.
  • Returning to Work:
    • You can return to desk jobs or light duties within 1-2 days.
    • Physically demanding jobs may require several weeks for a full return.
  • Driving: Most patients can drive within a few days to two weeks, depending on comfort and the type of surgery performed.

What are the Risks and Complications of Carpal Tunnel Release Surgery?

While carpal tunnel release is mostly safe and highly effective, it does carry some risks and potential complications. These include:

  • Infection: There is always a risk of infection at the incision site, which may require antibiotics or additional treatment.
  • Bleeding: Minimal bleeding is expected, but excessive bleeding may occur in rare cases.
  • Pain, Stiffness, and Swelling: Temporary discomfort, swelling, and reduced mobility are common after surgery.
  • Nerve Injury: Damage to the median nerve or its branches, though rare, could lead to worsened symptoms, numbness, or weakness.
  • Blood Vessel Injury: Damage to arteries or veins during the procedure is rare but possible.
  • Incomplete Symptom Relief: If significant nerve damage existed before surgery, symptoms like pain, numbness, or weakness may not fully resolve.
  • Scar Sensitivity or Pain: Scarring is typical, but some patients may experience tenderness or sensitivity around the incision site.
  • Wound Healing Problems: Delayed healing or poor scar formation could occur, particularly in individuals with certain medical conditions like diabetes.
  • Chronic Pain (Complex Regional Pain Syndrome - CRPS): A rare but serious condition causing persistent pain and swelling after surgery.
  • Adverse Reactions to Anesthesia: Allergic or other adverse reactions to anesthesia used during the procedure.

Minimizing Risks of Carpal Tunnel Release

To reduce the likelihood of complications:

  • Choose a qualified, experienced surgeon and medical facility with the latest technologies.
  • Follow all pre-and post-operative care instructions from your healthcare provider.
  • Promptly report any unusual symptoms, such as fever, redness, swelling, or worsening pain.

What are the Benefits of Carpal Tunnel Release?

Benefits of Carpal Tunnel Release

Carpal tunnel release surgery offers various benefits for those suffering from carpal tunnel syndrome (CTS). One primary advantage is significant relief from pain, tingling, and numbness in the hand and fingers. As a result, many patients experience improved grip strength and overall hand function, making it easier to perform everyday tasks and return to work without discomfort.

The surgery also provides a long-term solution for severe cases of CTS, reducing the risk of permanent nerve damage and muscle atrophy in the hand. For many patients, this procedure greatly enhances their quality of life, allowing them to engage in activities previously hindered by pain and limited hand function.

In addition to these improvements, carpal tunnel release surgery has a high success rate, with most patients experiencing long-term relief from their symptoms. Particularly with endoscopic surgery, the recovery time is often quicker, and many individuals can resume daily activities within a few weeks of the procedure. It makes the surgery an effective option for patients seeking a durable solution to their carpal tunnel issues.

To Conclude

Carpal tunnel syndrome is a frustrating and limiting condition, but with proper treatment—whether nonsurgical or surgical—most people find lasting relief. If you're facing surgery, rest assured that it's a common procedure with a high success rate. Talk to your doctor about the best options for your situation, and take steps to protect your hands for the future.

Author

Doctor of Pharmacy

Dr. Deepanshu Siwach is a skilled clinical pharmacist with a Doctor of Pharmacy degree. He has 4+ years of experience and has worked with thousands of patients. He has been associated with some of the top hospitals, such as Artemis Gurgaon.

Reviewer

Dr. Aashish Chaudhry is amongst the best Orthopedic Surgeons, with over 23 years of experience....

Frequently Asked Questions

Carpal tunnel release surgery takes around 20-30 minutes to complete.

While you may feel sore after surgery, the pain is usually mild; doctors manage it with medication.

Local or regional anesthesia is used to numb the wrist and hand, allowing you to remain awake but pain-free during the procedure.

CTS is normally an outpatient procedure, meaning you can go home the same day.

The time it takes to return to work depends on the nature of your job. You can resume light duties within a few days, but manual labor or physically demanding tasks may require 4-6 weeks of recovery.

While it is rare, carpal tunnel syndrome can reoccur, especially if the underlying cause is not properly addressed.

Patients can reduce their risk of developing CTS by maintaining neutral wrist positions, taking regular breaks during repetitive tasks, using ergonomic tools and workstations, and performing exercises to strengthen their hand and wrist muscles.

Most people experience significant relief and regain full use of their hands after carpal tunnel release surgery. However, full recovery may take a few weeks, depending on the severity of the syndrome before the surgery.

Looking for the best doctor ?

Fill up the form and get assured assitance within 24 hrs!

Reviews

Trusted by Patients