Houston Methodist. Leading Medicine

Hand FAQ

Question:

I can't decide if I should or shouldn't have carpal tunnel surgery. I'm worried I won't be able to get my work done at home or at work. But I'm also aware that there are quite a few things I'm not doing very well because of the pain and numbness. How do other people make this decision?

Answer:

Carpal tunnel syndrome is a common nerve compression problem in adults, so you might think with the number of people being treated for this problem that we would have a lot of data on it. But, in fact, there are far more studies investigating decision-making over joint replacements than carpal tunnel syndrome. The most recent evidence-based approach has been to conduct electrodiagnostic tests such as nerve conduction velocity (NCV) and electromyography to confirm the diagnosis. If the results of these tests support a median nerve compression neuropathy, then surgery is advised. If the studies are negative, then patients are treated with conservative measures such as antiinflammatory medications, steroid injections, splinting, and/or exercises and hand therapy. Knowing that those tests are not 100 per cent reliable, there are some patients who complete the recommended course of nonoperative care and still go on to have surgery because their symptoms don't get better. Sometimes for patients who don't get better (or who may even get worse), repeat electrodiagnostic tests are done after six months. At that point, they may show that degeneration of the nerve has occurred over time. One small study of Korean homemakers with carpal tunnel syndrome of unknown cause may give you some insight into some peoples' thinking. All were scheduled to have surgery. But after a four-week waiting period, 13 per cent cancelled the operation. When interviewed and asked why they cancelled, they said their symptoms had gotten better. For those patients who didn't cancel, they reported the severity of their pain and numbness was the main reason they went ahead with the operation. Knowing how other people decide may be interesting, but it may not always be helpful. Each patient must take into consideration the individual factors of his or her own situation. Test results, current function, goals, general health, and insurance coverage must all be evaluated when making the final decision. Your surgeon can also offer his or her perspective based on your history, age, and clinical findings. Hyun Sik Gong, MD, PhD, et al. Factors Affecting Willingness to Undergo Carpal Tunnel Release. In The Journal of Bone & Joint Surgery. September 2009. Vol. 91A. No. 9. Pp. 2130-2136.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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