Houston Methodist. Leading Medicine

Hand FAQ

Question:

Mother is 82-years-old and loves to knit and crochet. She has made over 100 blankets for our local hospice. But she has terrible carpal tunnel syndrome and wants to have surgery. What are the risks and how do other people come out of this surgery? She's pretty healthy otherwise but slowing down.

Answer:

There is plenty of research evidence to support the benefits of surgery to release the soft tissues around the affected (median) nerve in the general adult population. But no one has really studied the results of surgical release in the older adult group. The procedure can be done in one of two ways: with an open incision or with a minimally invasive approach and very small incision. The advantages to the older adult of endoscopic carpal tunnel release for carpal tunnel syndrome are many: less pain after the surgery, return of hand function faster, and improve grip and pinch strength more quickly than with open incision surgery. The two disadvantages of endoscopic release are: 1) possibility of nicking the nerves and blood vessels in the carpal tunnel and 2) the potential for an incomplete release. There is evidence from studies that before surgery, the majority of patients report constant numbness as the primary symptom. Numbness is the most typical symptom associated with carpal tunnel syndrome. True pain may be present in a small percentage of sufferers but in many cases, the numbness is so severe that it is interpreted as pain. Many patients are treated conservatively (splinting, steroid injection) before trying surgery. Some are able to get partial relief from their symptoms but not enough to avoid surgery. Those patients who report "pain" before surgery are able to get relief from their pain following the carpal tunnel release procedure. Numbness before surgery (especially noticeable at night) can also be eliminated with carpal tunnel release surgery. According to one recent study, the procedure is considered a success in older adults and (older) age was not a factor linked with poor results. The findings of this study are very encouraging for older adults like your mother who are affected by carpal tunnel syndrome. John D. Beck, MD, et al. Clinical Outcomes of Endoscopic Carpal Tunnel Release in Patients 65 and Over. In The Journal of Hand Surgery. August 2013. Vol. 38A. No. 8. Pp. 1524-1529.

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