Does Carpal Tunnel Surgery Work?

A look at your treatment options ...

If the eyes are a window to the soul, then the carpal tunnel is a window to pathology.  Let me explain.

The carpal tunnel is a passageway through which the median nerve and tendons to the fingers pass.  The carpal tunnel exists at the base of the palm near the wrist.  Carpal tunnel syndrome happens when there is impingement on the median nerve, which runs through the carpal tunnel.  The fact that carpal tunnel syndrome is linked to so many other diseases makes it a window to pathology.

  These diseases are genetic (amyloidosis), rheumatologic (arthritis) and endocrine (diabetes).

Despite its association with a variety of diseases, however, carpal tunnel syndrome is most often caused by repetitive-use injuries, which occur to dental hygienists, textile workers, secretaries, mechanics and assembly line workers.

The pain, tingling and numbness caused by carpal tunnel system can be disabling and demand medical treatment.  Treatment for carpal tunnel syndrome is initially conservative (nonsurgical).  Conservative measures like steroid shots can result in limited relief.  However, for those with progressive or severe disease, the best treatment option is surgery.

Carpal tunnel syndrome affects about 4 percent of all people.  In those people with the disease, carpal tunnel produces numbness, tingling and pain in the thumb, index and middle fingers as well as half the ring finger and part of the palm.

  These deficits present along where the median nerve distributes or innervates.

Carpal tunnel syndrome begins with pain (even on light touch), progresses to loss of sensation and culminates with weakness and wasting away of the thumb muscles.  The pain of carpal tunnel can become severe with even light touch eliciting excruciating pain, burning or tingling (a phenomenon called dysesthesia).

Initially, many people with carpal tunnel syndrome experience swelling and tingling that's worse at night.  Early during the course of the disease, this discomfort can be relieved by shaking the hands or changing hand position. Ultimately, carpal tunnel syndrome can result in weakness of the fingers and inability to carry out fine movements. 

In addition to occupation-related injury including repetitive use and vibration, there are other risk factors for carpal tunnel syndrome.  These risk factors include:

  • female sex
  • older age
  • pregnancy
  • obesity
  • lipid abnormalities or "high cholesterol" (data limited to Japanese populations)
  • wrist characteristics (widened palm and squared carpal tunnel)
  • hypothyroidism
  • family history
  • treatment with aromatase inhibitors such as tamoxifen
  • osteoarthritis
  • renal failure (possibly due to amyloid build-up)

The diagnosis of carpal tunnel is often based on history and physical exam findings (Tinel sign and Phalen test) and a detailed neurological exam.  However, nerve conduction studies (NCS) and electromyogram (EMG) are the best ways to diagnose the disease; these procedures are typically performed by a neurologist or physiatrist. 

If your clinician is unsure whether you have carpal tunnel syndrome or wants to determine the severity of the disease, NCS and EMG are your best bet.

  Furthermore, these tests are ordered before surgery. 

Unless there's a tumor or mass impinging on the median nerve, MRI isn't all that useful when diagnosing carpal tunnel syndrome.  Furthermore, x-ray of the wrist is useful only when there's a bony deformity or so forth.  Ultrasound is emerging as a means of diagnosis of carpal tunnel and can detect swelling of the median nerve which contributes to impingement.

Treatment for carpal tunnel syndrome is initially conservative and includes NSAIDs (drugs like ibuprofen), oral steroids, splinting, tendon gliding exercises, acupuncture, and steroid shots.


Of these conservative treatments, steroid shots are most effective, and in mild cases of carpal tunnel syndrome, one steroid shot may result in long-term relief.  However, people with wasting of the thumb muscles (thenar atrophy) should not receive steroid shots.  Furthermore, if you need more than two shots, you'll likely be referred to surgery.

Surgery for carpal tunnel syndrome involves splitting the transverse carpal ligament which forms the roof of the carpal tunnel.  By splitting this connective tissue, more room is made for the median nerve and it is thus released.  

Carpal tunnel release is one of the most successful surgeries in medicine with more than 90 percent of people claiming satisfaction and experiencing excellent outcomes.  If you or someone you love suffers from severe carpal tunnel syndrome, surgery may be a good option.

Selected Sources

Article titled "In the Clinic: Carpal Tunnel Syndrome" by KA Kleopa from the Annals of Internal Medicine published in 2015.

LeBlond RF, Brown DD, Suneja M, Szot JF. The Spine, Pelvis, and Extremities. In: LeBlond RF, Brown DD, Suneja M, Szot JF. eds. DeGowin’s Diagnostic Examination, 10e. New York, NY: McGraw-Hill; 2015. Accessed September 17, 2015.

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