If the pain has become unbearable and no therapeutic or medical treatments have worked, it might be time to consider surgery for your carpal tunnel syndrome.

Carpal tunnel syndrome is a compression of the median nerve that runs through your wrist.

Women are three times more likely to develop the condition, and people in assembly-line work often are affected by it. The result is nagging pain, tingling and numbness in the hand, fingers or thumb. Upon diagnosis, your doctor may recommend a night splint, medical treatments and a variety of therapies to alleviate the pain.

“Think of the hand as a plant, while the median nerve, which supplies power and feeling to the hand, is similar to a garden hose,” said Alidad Ghiassi, MD, assistant professor of clinical orthopaedic surgery at the Keck School of Medicine of USC. “If the garden hose is compressed, then the plant will not receive what it needs to function. This is when patients have symptoms. Surgery is designed to take the pressure off the hose and allow the water to flow.”

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At centers such as the Hand Center at Keck Medicine of USC, certified hand therapists combine occupational therapy (OT) and physical therapy (PT) techniques to assess your injury and restore function. Once you have exhausted these options, surgery may be the only way to relieve pain or cure your carpal tunnel syndrome. Only in rare cases will your doctor suggest surgery if your symptoms have just started.

Do you need surgery?

You may be unsure of whether surgery is the right option for you. We asked Dr. Ghiassi, who also is an orthopaedic surgeon specializing in hand surgery at Keck Medicine of USC, to weigh in on these questions:

  • How do you know if the issue is carpal tunnel or something else?

“Usually patients will have pain and sensory change in the hand and forearm, especially at nighttime or early-morning hours. In the early stages of carpal tunnel syndrome, this is temporary, but if not treated, it can lead to loss of power and feeling in the hand.”

  • Will surgery cure my carpal tunnel syndrome?

“Surgery will prevent progression of disease and allow the compressed nerve to regenerate. It helps treat pain, and if treated early, the hand will have return of normal function.”

  • Can carpal tunnel recur after surgery?

“Rarely, unless we can identify a specific risk factor that is not addressed after surgery.”

  • What are the risks of surgery on use and mobility?

“Mobility is rarely an issue after surgery. Most patients can do home therapy once sutures are removed. However, if there is longstanding nerve compression with loss of sensation and atrophy, then the return of function is less predictable.”

How is surgery performed?

“Carpal tunnel release” is the term for surgery that helps relieve or eliminate pain by dividing a fibrous band near the wrist called the flexor retinaculum. Your doctor will release the ligament through an incision on the inside of the wrist.

What is my recovery time for carpal tunnel release?

The surgery can be performed on an outpatient basis. You’ll be able to use your fingers and hand for basic activities immediately after surgery.

After two weeks, you can resume other normal activities — except those that put pressure on the palm. Six weeks post-surgery, you should be fully recovered, though you might feel some discomfort during pushups and other strenuous activities. According to Dr. Ghiassi, this is not because of the recovery of the nerve but rather recovery from the incision.

“For patients with longstanding nerve compression, it may take up to a year to get sensation and power back,” Dr. Ghiassi explained.

Is there anything I can do to make sure my carpal tunnel syndrome doesn’t return?

Injections can be helpful but not always successful in the early phase of carpal tunnel syndrome. Therapy does not play a large role in treatment, however, activity modification and mindfulness, including postural control, stress relaxation, diet and exercise, can be successful.

By Heidi Tyline King

Considering surgery? Consult with the specialists at USC Orthopaedic Surgery at Keck Medicine of USC. To schedule an appointment, call (800) USC-CARE (800-872-2273) or visit http://ortho.keckmedicine.org/patient-information/request-an-appointment/.