Does Carpal Tunnel Surgery Really Work?

The symptoms of carpal tunnel syndrome, such as hand pain, numbness, and weakness, can be disruptive. There are many ways for you to find relief, including carpal tunnel surgery. 

Carpal tunnel release surgery can help to improve your symptoms when other treatments don’t work. Let’s take a closer look at treatment options for carpal tunnel, how carpal tunnel surgery works, and when it might be useful. 

Quiz: Do I have carpal tunnel syndrome?

What is carpal tunnel release surgery?

Carpal tunnel release surgery is a treatment option to relieve the symptoms of carpal tunnel syndrome. Carpal tunnel syndrome is caused by the pinching of the median nerve as it passes through the carpal tunnel in the wrist. This tunnel is formed by some bones and the transverse carpal ligament in the wrist. Release surgery cuts the ligament, making more room for the median nerve so it isn’t pinched. 

The median nerve controls some muscles of the hand and supplies sensation to the thumb, index, and middle finger. When the median nerve is pinched at the wrist, you may feel hand pain, numbness, and tingling. Muscle weakness may be present in severe cases. Carpal tunnel release helps to improve these symptoms by relieving the pressure on the nerve.

What are the treatment options for carpal tunnel syndrome?

Treatment for carpal tunnel syndrome usually starts with conservative options. This includes a variety of nonsurgical treatments. People who don’t improve or have severe symptoms may need carpal tunnel release surgery. 

Nonsurgical treatment options

Not all people with carpal tunnel syndrome need surgery. Several conservative measures could help your carpal tunnel symptoms. These include:

•  Avoiding repetitive movements of the hand and wrist: Repetitive movements, such as typing, texting, or playing instruments may increase the chances of having carpal tunnel syndrome.

• Using a splint: A splint with the wrist at a neutral position may help reduce repetitive motions and the pressure on the nerve.

• Stretching the wrist: Manual therapies done at home to stretch the carpal ligament may improve numbness, tingling, and strength.

• Starting physical therapy: Physical therapy can be helpful, especially if your symptoms aren’t severe. This may include heat, electrical stimulation, ultrasound, and exercise.

• Using injections: Corticosteroid injections may help decrease inflammation in the carpal tunnel.

• Taking medication: Over-the-counter (OTC) or prescription anti-inflammatory medications may help some people with their symptoms.

Surgical treatment options 

When conservative treatments don’t work to relieve your carpal tunnel syndrome symptoms, surgery may be an option. Carpal tunnel release surgery can be done using different methods, such as:

• Open release surgery: This is the traditional carpal tunnel surgery. Your surgeon is able to see the carpal tunnel directly through an open incision at the wrist.

• Endoscopic surgery: This is a less invasive option and is frequently used. The surgeon will make one or two smaller incisions and insert a small camera to view the tunnel and cut the ligament.

• Ultrasound-guided release: This is a newer procedure using ultrasound to find the carpal tunnel and median nerve. This technique uses a much smaller incision, so you can get back to your activities faster. 

The type of carpal tunnel surgery you have often depends on the surgeon’s experience. “Most surgeons do whatever they are comfortable with or what they are trained in,” said Dr. Karan Desai, hand surgeon at Orlando Health Jewett Orthopedic Institute.

Open release and endoscopic surgery have similar results over the long term. Dr. Desai said that most hand surgeons use a minimally invasive approach. The scars “are extremely small and the recovery is much faster,” he said. But, if someone has had hand surgery in the past, open release is usually preferred. That’s because other methods are hard to do if you have scarring from previous surgeries.

When is carpal tunnel release necessary?

If you continue to have symptoms after trying nonsurgical treatments, you may need carpal tunnel release. Conservative treatments are usually tried for up to 3 months. If there’s no improvement during that time or your symptoms worsen, your healthcare provider may suggest carpal tunnel surgery. 

Your hand specialist may also recommend carpal tunnel surgery sooner than later if there are symptoms like:

• Constant numbness or weakness

• Atrophy in the hand muscles

• Evidence of severe nerve entrapment on a nerve conduction test 

What are the risks of carpal tunnel surgery?

While there’s the huge benefit of symptom relief after carpal tunnel surgery, there are still some risks. Carpal tunnel release complications may include:

• Nerve injury

• Infection

• Tendon damage

• No improvement or worsening of symptoms

• Ongoing numbness or tingling

• Temporary surgical site pain or “pillar pain”

• Painful scar 

What is the success rate of carpal tunnel surgery?

Experts report that 75% to 90% of people have a successful carpal tunnel surgery with improvement of symptoms. Complete recovery is common, especially for people who don’t have other conditions in the hand or wrist, like arthritis or tendinitis. Carpal tunnel syndrome can return in some people, but this rarely occurs.

How long does it take to recover from carpal tunnel surgery?

Pain and numbness may improve right after carpal tunnel surgery. But, complete recovery may be gradual, and can take up to a year. According to Dr. Desai, if your symptoms have been going on for a very long time, the nerve may take longer to recover or may never recover completely. But pain is usually greatly improved even if sensation doesn't come back fully. 

You may need rest from work and daily activities for a couple of weeks. But most people return to their normal activities within a month or sooner. And hand therapy can be helpful in the recovery process. Michelle M. McMurray, certified hand therapist, and co-chair of the ASSH Public Education Committee, said that hand therapy may involve:

• Changing dressings

• Managing swelling

• Gliding exercises (gentle exercise to help move the nerve and tendon)

The scar may be tender for several months. That’s why McMurray recommends a good home program that includes scar massage and exercise after having your sutures removed. This improves mobility and reduces sensitivity in the area.

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Written by:

Itza Rivera, MD

Dr. Rivera is a board-certified physical medicine and rehabilitation specialist. She completed her medical degree and residency training at the University of Puerto Rico School of Medicine, and her neuromuscular disorders subspecialty training at Northwestern University.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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