When Is Carpal Tunnel Bad Enough for Surgery?

Carpal tunnel syndrome is a familiar and widespread medical condition that can cause numbness, pain, or tingling in the wrist, hand, and forearm. While most people who experience mild symptoms of carpal tunnel syndrome find relief through non-surgical treatments, there are cases where symptoms persist or worsen, making daily activities challenging or impossible, prompting the need for surgical intervention.

In this blog, we’ll explain what carpal tunnel syndrome is, examine the stages of its severity, and explain what symptoms are bad enough to merit considering surgery.

What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome occurs when the median nerve, which runs from your forearm into your palm through a passageway in your wrist, becomes compressed or squeezed for a prolonged period of time. This narrow passageway, surrounded by bones and ligaments, is called the carpal tunnel: when this tunnel becomes narrowed or when tissues surrounding the flexor tendons swell, they can press on the median nerve. This causes feelings of numbness, tingling, and pain in the hand and wrist.

What Causes Carpal Tunnel?

Carpal tunnel syndrome primarily occurs due to inflammation of tissue within the wrist. It’s often associated with repetitive hand movements that involve flexion and extension of the wrist, as well as gripping, pinching, and twisting motions. Some common sources of these repetitive motions include:

• Typing
• Using a computer mouse
• Assembly line work
• Using vibrating tools such as jackhammers or drills
• Playing musical instruments
• Knitting or crocheting
• Using handheld devices such as smartphones and game controllers

There are also many associated medical conditions that can increase a patient’s risk of developing carpal tunnel, such as:

• Diabetes
• Hypothyroidism
• Rheumatoid arthritis

Carpal tunnel can also develop in an acute trauma setting such as when a patient fractures their wrist.

What Are the Symptoms of Carpal Tunnel?

Common symptoms of carpal tunnel syndrome include:

• Numbness
• Tingling
• Pins and needles sensations
• Burning pain usually felt in the thumb, Index finger, and middle finger
• Pain that radiates up the arm

What Are the 5 Stages of Carpal Tunnel?

Carpal tunnel syndrome doesn’t have officially defined stages, but its progression can be categorized by the severity of its symptoms.

1. Early Symptoms – This includes mild and intermittent symptoms, such as occasional tingling, numbness, or burning sensations in the thumb, index, middle, and ring fingers. The discomfort usually occurs at night or first thing in the morning but may subside quickly with shaking or massage.
2. Increasing Discomfort – Aching in the wrist and forearm, weakness in the hand, and difficulty gripping objects may start to develop. Symptoms generally become more frequent and persistent, lasting longer throughout the day and occasionally disrupting sleep.
3. Persistent Symptoms – Numbness and tingling start to affect daily activities, and hand weakness and clumsiness make it difficult to perform fine tasks that require fine motor skills. Pain may begin to radiate up the arm.
4. Chronic Pain – Persistent pain, numbness, and tingling significantly impact quality of life, making everyday tasks such as buttoning clothes, opening jars, or holding utensils difficult. Muscles can begin to atrophy (especially in the thumb) and the patient loses grip strength.
5. Functional Impairment – If left untreated, irreversible nerve damage can occur. The patient experiences constant pain, numbness, and weakness along with significant loss of hand function and dexterity.

When Is Surgery Required for Carpal Tunnel?

In order to prevent the condition from progressing and causing permanent nerve damage, surgery is highly recommended when symptoms persist despite the use of conservative non-surgical treatments, such as bracing, non-steroidal anti-inflammatories, and steroid injections.

Persistent symptoms that merit surgical intervention include:

• Constant tingling, pain, and numbness
• Symptoms that interrupt sleep or prevent you from falling asleep

Surgery is also necessary when an acute trauma, such as a fractured wrist, leads a patient to develop acute carpal tunnel syndrome symptoms very quickly.

Surgical Options for Carpal Tunnel

There are two common surgical treatments for carpal tunnel syndrome: open carpal tunnel release surgery and endoscopic carpal tunnel release surgery.

Open Carpal Tunnel Release Surgery

First, a 2 to 5 cm incision is made in line with the carpal tunnel. The ligament of the carpal tunnel is then exposed and released creating more space within the tunnel and allowing better blood flow to the nerve. The surgeon may also remove inflammatory tissue during an open carpal tunnel release, but it isn’t usually necessary.

Endoscopic Carpal Tunnel Release Surgery

A small, 1 cm incision is made in the wrist. Then the doctor inserts a thin, flexible tube with a tiny camera (called an endoscope) to guide the surgery. The ligament can then be safely released with a surgical instrument that is built into the device.

Endoscopic surgery generally results in smaller incisions, less pain, faster recovery, and less scarring compared to open surgery, but it requires specialized equipment and expertise and has a slightly higher risk of nerve injury.

What Are the Benefits and Risks of Carpal Tunnel Surgery?

Results will depend on the severity of the patient’s carpal tunnel symptoms; however, the benefits are the cessation of pain – especially nighttime symptoms – and a significant reduction or elimination of numbness, tingling, and burning sensations in the hand and wrist. Patients with cases that are extremely severe may have suffered permanent pre-existing nerve damage from the condition and may only experience an alleviation of symptoms rather than their complete disappearance. In either case, the surgery reduces the risk of further nerve damage, it can restore hand function and strength, and it can improve overall quality of life, especially improved sleep and improved ability to perform day-to-day tasks.

Complications from carpal tunnel surgery are relatively rare, and they mostly consist of the usual risks that attend any surgery, such as scarring, pain or stiffness post-surgery, and the possibility of bleeding or infection.

How Long Does Recovery from Carpal Tunnel Surgery Take?

Recovery from carpal tunnel surgery is generally very quick. Patients are instructed to begin to use the hand as pain allows on the first day after the operation. Recovery usually takes 3 – 7 days and stitches are removed after one to two weeks. The full extent of a patient’s recovery will always vary, though, based on individual healing time, the severity of the symptoms prior to surgery, and patient adherence to post-operative instructions.

How Well Does Carpal Tunnel Surgery Work?

Carpal tunnel surgery has very high success rates and can significantly improve patients’ symptoms. About 90% of patients report that they’re happy they had the surgery, and the risk of re-operation is very small: less than 5%. How fully a patient improves depends in part on how far their condition has progressed before they seek surgery, which is why it’s important to see an orthopedic doctor early when you begin to experience symptoms rather than delaying treatment.

Are There Non-Surgical Treatment Options for Carpal Tunnel?

Yes, there are a number of non-surgical treatment options for carpal tunnel syndrome that your doctor will probably recommend before considering surgery. These include:

• Nighttime wrist braces
• Non-steroidal anti-inflammatory medications (NSAIDs) such as aspirin and ibuprofen
• Physical therapy for nerve gliding exercises
• Corticosteroid injections into the carpal canal

What Happens if Carpal Tunnel Is Left Untreated?

If the compression is significant enough, the median nerve will eventually begin to degenerate, which will lead to permanent sensory loss in the thumb, index finger, and middle finger as well as weakness in the hand with grip and pinch strength.

FAQs about When and Whether Carpal Tunnel Is Bad Enough for Surgery

When Should You See a Doctor for Carpal Tunnel?

It’s important to see a doctor in the early stages of carpal tunnel syndrome to have the best chance at full recovery without surgery. See a doctor if you’re regularly or persistently experiencing symptoms of pain, numbness, or tingling in your hands and wrist.

Can You Fully Recover from Carpal Tunnel Syndrome Without Surgery?

Yes, it’s possible to fully recover without surgery. Occasionally the nerve is simply irritated, and with bracing, NSAIDs, or an injection, the inflammation can decrease and the nerve can recover on its own.

What Conditions Are Often Misdiagnosed as Carpal Tunnel Syndrome?

Some other conditions that are often misdiagnosed as carpal tunnel syndrome include:

• Arthritis
• Cubital tunnel syndrome
• Vitamin deficiencies
• Cervical radiculopathy
• Pronator syndrome

Can Carpal Tunnel Come Back After Surgery?

Yes, it’s rare but carpal tunnel syndrome can recur after surgery. The recurrence rate is usually less than 2% within 10 years.

How Much Time Off Is Needed for Carpal Tunnel Surgery?

At Alexander Orthopaedic, we recommend patients take a full week off work for their surgery – however, many patients return to work one to two days after surgery. How quickly a patient can return to work also depends on their occupation.

Trust Alexander Orthopaedics to Treat Your Carpal Tunnel Syndrome

At Alexander Orthopaedic Associates, we work carefully with our patients to make sure you understand all your options. If you’ve been living with hand, wrist, and forearm pain and want to explore ways to feel better, schedule an appointment today.