Carpal Tunnel Syndrome (CTS) is the most common nerve entrapment condition, occurring when the median nerve is compressed as it passes through the narrow passageway in the wrist known as the carpal tunnel. This compression leads to symptoms including numbness, tingling, and pain, primarily affecting the thumb, index, middle, and half of the ring finger. Symptoms often worsen at night or during activities that require repetitive gripping or wrist flexion, sometimes causing a patient to “shake out” their hand for relief. Surgery is reserved for cases where the condition is significantly advanced or unresponsive to less invasive methods.
Exhausting Non-Surgical Treatment Options
The first line of defense against Carpal Tunnel Syndrome involves conservative treatments intended to reduce pressure and inflammation around the median nerve. Initial steps focus on modifying activities that aggravate symptoms and ensuring the wrist is kept in a neutral position, particularly during sleep. Night splinting or bracing is a recommended intervention, as it prevents the wrist from bending, a position that increases pressure on the nerve.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may provide temporary pain relief but do not treat the underlying nerve compression. Physical therapy, including nerve gliding exercises, can also be helpful in managing mild to moderate cases. If these initial methods fail to provide sustained relief, a doctor may suggest a corticosteroid injection directly into the carpal tunnel.
The injection delivers a powerful anti-inflammatory medication that can reduce swelling and provide short-term symptom relief, sometimes lasting for several months. For many people with mild to moderate CTS, these non-surgical approaches are sufficient. However, the failure of these treatments, especially the lack of sustained improvement after a steroid injection, indicates that the condition is advancing and that surgical consultation is necessary.
Objective Measures Indicating Severe Nerve Compression
The decision to proceed with surgery is guided by objective evidence of severe nerve damage, moving beyond the patient’s subjective experience of pain. One physical sign of advanced, long-standing compression is thenar muscle atrophy, a visible wasting of the muscles at the base of the thumb. This atrophy indicates the median nerve has been severely compromised, leading to noticeable weakness in grip and pinch strength.
For a definitive assessment of nerve health, electrodiagnostic studies are performed, involving Nerve Conduction Studies (NCS) and Electromyography (EMG). The NCS measures the speed and strength of electrical signals traveling through the median nerve at the wrist. Severe CTS is indicated by a significant slowing of the nerve’s conduction velocity or a substantial reduction in the signal’s amplitude, confirming functional impairment.
Electromyography involves inserting a thin needle electrode into the small muscles of the hand to assess their electrical activity. Signs of denervation or axonal loss—evidence that the nerve fibers are dying off—are definitive markers of a severe condition. Such conditions will not recover without surgical intervention.
What to Expect from Carpal Tunnel Release Surgery
When objective measures confirm severe, persistent compression, carpal tunnel release surgery is performed to alleviate pressure on the median nerve. The procedure’s goal is to cut the transverse carpal ligament, which forms the roof of the carpal tunnel, immediately increasing space for the nerve. This release of tension provides long-term symptom relief.
The surgery is typically performed as an outpatient procedure using local anesthesia. Two main techniques are used: open release, which involves a small incision to cut the ligament under direct visualization, and endoscopic release. The endoscopic method uses a smaller incision and a camera to guide the cutting, potentially offering a slightly faster initial recovery.
Following the procedure, the hand is usually bandaged or placed in a splint for one to two weeks. Patients are encouraged to move their fingers immediately to prevent stiffness, but heavy gripping and lifting are restricted for several weeks. While light daily activities resume within a few days, the full recovery of strength and sensation typically spans three to four months, with complete hand strength possibly taking up to a year to return.