What is carpal tunnel syndrome and how does surgery work?

Carpal tunnel syndrome is a common hand condition that can cause symptoms of numbness, tingling, weakness or pain. Sometimes referred to as a pinched nerve, this condition occurs when the median nerve – one of the major nerves in the hand – is compressed as it travels through the small space in your wrist called the carpal tunnel.

The median nerve originates in the neck, travels down the arm, and passes through the carpal tunnel in the wrist with several tendons that control movement and feeling in your thumb and first three fingers.

What causes carpal tunnel syndrome?

While the exact cause of carpal tunnel syndrome is unknown, it seems to occur when there’s excess pressure on the median nerve. Repetitive movements and vibration may contribute to this pressure.

Some activities or occupations can increase the likelihood of experiencing carpal tunnel syndrome symptoms, especially those involving extended periods of wrist flexion or extension. Individuals working with laboratory instruments, power tools like drills or jackhammers, or operating trucks may have a higher risk for this condition.

Other causes may include:

• Injury to your upper extremity, such as a broken wrist
• Certain medical conditions, such as:
  • arthritis
  • rheumatoid arthritis
  • diabetes
  • hypothyroidism
  • gout
  • amyloidosis
  • ganglion cysts

It’s also associated with increasing age, being a woman, and other conditions including pregnancy, menopause and obesity. Smokers and individuals with alcohol use disorder are also at increased risk.

What are the symptoms of carpal tunnel syndrome?

Symptoms of carpal tunnel syndrome include:

• tingling
• numbness
• weakness
• pain in the palm side of the hand and fingers, mainly affecting the thumb, index, middle and half of the ring finger. Some may also feel pain between the hand and elbow.
• trouble using your hands to hold or control objects (for example: holding your phone, gripping the steering wheel, holding a pen or typing on a keyboard)

Symptoms can worsen at night and wake you up, especially if you’re having pain.

How is carpal tunnel syndrome diagnosed?

If you have persistent symptoms, you should see a doctor. They can review your symptoms and medical history and perform a physical exam. They may also order nerve conduction studies or an ultrasound to help confirm the diagnosis, rule out other conditions, and determine the severity of the nerve compression.

What treatments are available for carpal tunnel syndrome?

Depending on the severity of your symptoms, treatment for carpal tunnel syndrome may include:

• wearing a wrist splint or brace at night
• hand therapy exercises
• corticosteroid injections
• surgery (carpal tunnel release)

When is carpal tunnel surgery necessary?

Surgery is usually recommended when conservative treatments fail to improve symptoms. Persistent and severe symptoms can lead to permanent nerve damage. In many instances, carpal tunnel release surgery can help alleviate symptoms and, in some cases, even fix nerve damage.

At The Ohio State University Wexner Medical Center, our expert hand surgeons at the Hand Center can perform carpal tunnel release while you receive sedation (“twilight” anesthesia) or while you’re awake through a surgery method called WALANT (wide awake, local anesthesia, no tourniquet). We direct local anesthetic into the surgical site so that you won’t feel pain during the procedure, even if you’re awake.

Recovery after carpal tunnel surgery

Recovery after carpal tunnel release surgery can vary depending on the type of surgery you have.

Endoscopic carpal tunnel release surgery

This is a minimally invasive technique in which a thin tube with a camera (endoscope) is inserted through a small incision in the wrist, allowing the surgeon to guide a cutting instrument to sever the transverse carpal ligament. Patients have stitches removed a week after surgery.

Open carpal tunnel release

A traditional method, this consists of a larger incision in the palm, so it may require a longer recovery period. It may also delay a return to work by a few weeks.

Endoscopic surgery typically results in faster recovery, less pain and less scar sensitivity. Patients are able to return to work and other activities more quickly than with the traditional open method. There are also fewer restrictions after endoscopic surgery, though patients may experience some soreness and weakness in the hand until it regains strength.

Can carpal tunnel syndrome return after surgery?

It’s rare for carpal tunnel syndrome to come back after surgery, especially if the surgery is done properly and the carpal tunnel ligament is completely released. However, in a small subset of patients, carpal tunnel syndrome can return years or decades later if the ligament reforms or wasn’t completely released during the initial surgery. It can also return in patients who are at high risk with a condition like diabetes.