Carpal Tunnel Syndrome or Not

By Christopher Hankins, MD

I’ve been told that I need to have surgery for carpal tunnel syndrome. It is really hurting but I don’t want to have surgery. Are there any non-surgical alternatives you might recommend?

Dr Hankins’ Answer:

In answering this question, I am making the assumption that you have seen a hand or plastic surgeon, have undergone a physical examination and have had a nerve conduction study. There are a number of conservative measures that can be taken if the symptoms are of recent onset, such as activity modification, splinting at night and steroid injections to the carpal tunnel. However, if the symptoms do not go away completely within a short period of time, i.e., two weeks, it is best to undergo a decompression of the carpal tunnel, as the longer the compression of the median nerve (the nerve in the carpal tunnel) persists,  the greater the risk of permanent nerve injury.

In 2007, I authored a paper that was published in  Plastic and Reconstructive Surgery that reviewed a total of 14,722 patients with carpal tunnel syndrome who were treated with the endoscopic technique, the largest retrospective series published to date. What I noted from the data collected from this series of patients, was the direct correlation of the duration of symptoms and the incidence of permanent nerve injury. Moreover, review of the data also showed that the incidence of complications was much lower for the endoscopic over the open technique.

I recommend the endoscopic technique of release over the open technique for the following reasons: 1) The recovery time is much quicker. Most people can return to a desk job within a week of the surgery. I have seen patients return to work even faster if they were self-employed or they thought that their job was in jeopardy even though that was not recommended. With the open technique, the recovery can be as long as six weeks; 2) The safety record of the endoscopic technique as detailed above; 3) The lower scar burden associated with the endoscopic technique. Only the transverse carpal ligament is divided in the endoscopic technique, whereas in the open technique every layer of tissue from the surface of the nerve to the skin is divided, resulting in obliteration of gliding mechanism between the various tissue layers as they are now tethered with scar; and 4) The procedure only takes a few minutes to perform in experienced hands.

To summarize, in the case that conservative measures fail to completely relieve your symptoms within a two week period, surgical decompression should not be delayed. Endoscopic carpal tunnel release is safe and has a shorter recovery period than the open approach.

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