Carpal Tunnel Syndrome

If you have been diagnosed with carpal tunnel syndrome and your symptoms are interfering with your daily activities or frequently waking you up at night despite non-operative treatments such as modifying your activities, wearing a splint at night, or possibly an injection then you would likely benefit from carpal tunnel surgery. If your symptoms are constant you should consider surgery sooner rather than later.

When we sleep we tend to flex our fingers and wrists which increases the pressure on the median nerve at the carpal tunnel or wrist leading to symptoms of numbness, tingling and pain. There can also be fluid shifts in the arms when lying flat and not moving the fingers that can lead to increased pressure on the nerve as well.

The physical exam maneuvers can be useful in identifying where the nerve is pinched and the electrodiagnostic or EMG tests more definitively demonstrate where a nerve is pinched by measuring how the nerves conduct electricity and how the muscles supplied by the nerve are functioning. When the nerve is pinched at the wrist it conducts electrical signals slower than areas where it is not compressed.

Carpal tunnel surgery sometimes gets a bad rap in the community. It is a relatively simple procedure and one that is done by surgeons of multiple specialties including general surgeons, neurosurgeons, plastic surgeons, general orthopedic surgeons and hand surgeons. If the tight band constricting the nerve is not absolutely completely released, the symptoms will not improve and sometimes worsen. If you or someone you know have had a bad outcome from carpal tunnel surgery, it is worth exploring a second opinion with one of our hand specialists. Pain and night time symptoms are most predictably relieved within the first week after surgery. Numbness and weakness can take months to improve and may be permanent depending on your age, how long you have had the symptoms, how severely the nerve has been compressed, and on your other medical conditions such as diabetes or smoking.

Yes. This is based on patient and surgeon preference. With current surgical techniques, light use of the hands is permitted right away for activities such as dressing, feeding and using the restroom.

Carpal tunnel surgery is often done with a light sedation and then numbing the wrist and hand with a local anesthetic. However with advances in wide-awake local anesthesia no tourniquet (WALANT) techniques the surgery can also be done with just local anesthetic without sedation eliminating the need to fast as well as the risks of anesthesia for patients with medical issues or prior problems with anesthesia.

This depends on the nature of your work and the willingness of your work to accommodate light duty. Low demand activities such as clerical work can often be resumed within days after surgery. Higher demand activities can be resumed as tolerated often between 4 to 6 weeks after surgery.

You should not drive while taking narcotic pain medications. Once you are off the prescription pain medications and your pain is manageable to allow you to safely operate a vehicle you may resume driving. Often this is within a few days after surgery.

Everyone’s pain threshold and pain experience is different. Many people manage the pain with just acetaminophen (Tylenol) and/or ibuprofen (Advil) after surgery. The average number of stronger prescription pills taken is 3-5 pills over the first day or two.

If carpal tunnel syndrome is left untreated there is a risk of permanent nerve damage leading to loss of strength, muscle function at the base of the thumb, and loss of feeling in the thumb, index, middle and half of the ring fingers. If you have constant numbness where the fingers never fully wake up or feel normal, you should seek treatment more urgently. The longer it is left untreated, the longer it takes for the nerve to recover and the lower the likelihood of a full recovery.