Carpal Tunnel Treatment FAQ
What are the non-surgical options for carpal tunnel syndrome?
- Wrist splints. These are worn at night, to prevent the wrist bending (which increases the pressure on the nerve). They can be very effective in milder cases.
- Medical treatment of underlying causes of carpal tunnel syndrome e.g. hypothyroidism, rheumatoid arthritis, diabetes.
- Steroid injection. This is best when the underlying cause is inflammation within the carpal tunnel e.g. tenosynovitis. It is also useful as a temporary measure during pregnancy. In other situations, the long-term cure rates are low.
Is there any scientific evidence that chiropractic/homeopathy/vitamins can give permanent cure?
When should I consider surgery?
- When non-surgical options have failed, and you find the symptoms troubling. Mild symptoms do not necessarily need surgery.
- When you are at risk of permanent nerve damage (see below).
What are the results of surgery?
Carpal tunnel release is one of the most successful hand surgical procedures. Pain and tingling should rapidly vanish, sometimes by the next day. Numbness may take longer to improve, but usually does eventually resolve. Normal hand function is the expected outcome. We commonly hear "I wish I had done this years ago".
What are reasons for poor results?
- Irreversible nerve damage that occurred before the surgery. This is the commonest reason for persisting symptoms. Warning signs of this are:
- Severe changes on the nerve conduction studies
- Constant severe numbness before surgery
- Muscle wasting
- Inadequate surgical release of the carpal ligament, so that the nerve remains compressed. This should be very rare if an expert hand surgeon does the surgery.
- A second site of compression i.e. the nerve is compressed at another site, as well as at the carpal tunnel. The usual second site is in the neck/cervical spine. This does occur occasionally.
- Wrong diagnosis.
- Specific complications (these usually improve, but can take months):
- Tenderness or numbness around the scar
- Weak grip
- General complications.
Endoscopic vs Open surgery?
The long term results are identical. Endoscopic carpal tunnel decompression can give a quicker recovery and return to work, especially in manual workers. Some surgeons believe that the risk of major nerve injury is slightly higher with endoscopic release. Dr Rider has been trained in endoscopic release, but no longer performs this.
What should I expect post-op?
This is not generally a painful operation. The hand will be bandaged for 1-2 weeks, and must be kept dry. The fingers will be free, and you are encouraged to perform light activites. Office-workers can return to full duties in 1-2 weeks, manual in 4-6.
[ Post-op instructions ]
Does carpal tunnel syndrome recur?
Despite what you may have heard, this is rare.