Carpal tunnel syndrome: Should I have surgery?

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery for carpal tunnel syndrome.
Don't have surgery. Use rest, ice, medicine, wrist splints, and new ways to do some tasks.

Key points to remember

Home treatments may be all you need if you've had mild symptoms for a short time. You may be able to treat carpal tunnel syndrome with rest, ice, medicine, and wrist splints. You also can learn to do some tasks in a way that doesn't hurt your wrist. Surgery may be a better choice if you've had very bad symptoms for a long time.
Surgery for carpal tunnel syndrome may give you only a little relief if your symptoms are caused by other health problems, such as rheumatoid arthritis, hypothyroidism, or diabetes. Treating these problems often makes carpal tunnel symptoms get better or go away. But in some cases, you still might need surgery.
Sometimes surgery is needed to prevent lasting nerve damage. You will likely have a nerve test to see if you need surgery.
About 70 out of 100 people who have surgery for carpal tunnel syndrome are pleased with the results. This means that 30 out of 100 people aren't pleased. Up to 90 out of 100 people have no pain at night after surgery. So 10 out of 100 people still have some pain at night.¹
Symptoms of carpal tunnel syndrome in pregnant women often go away after childbirth. Unless your symptoms are very bad, you may want to wait and see if your symptoms go away after you have the baby.

FAQs

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a nerve problem that causes tingling, numbness, weakness, or pain in the fingers, thumb, or palm, and sometimes the forearm. These symptoms are caused by pressure on a nerve (median nerve) in the wrist (carpal tunnel).

See a picture of a wrist with carpal tunnel syndrome .

This problem is often linked to hand and wrist motions that you do a lot. These are called repetitive motions.

Swelling in the wrist—which can happen during pregnancy or because of a health problem—also can cause carpal tunnel symptoms or make them worse.

What problems can you have from carpal tunnel syndrome?

Severe carpal tunnel syndrome that lasts a long time can lead to permanent damage to the median nerve. This can make it hard for you to use your hand.

You may have:

Pain.
Weak thumb muscles. This makes it hard for you to grip or hold objects.
Loss of feeling and ability to use your fingers and hand well.

How does surgery fix carpal tunnel syndrome?

Surgery reduces the pressure on the median nerve in the wrist. The doctor cuts a ligament to relieve the pressure on the nerve.

The surgery is called carpal tunnel release . It can be done in one of two ways:

Open surgery: Your doctor makes a small cut (incision) in the palm of your hand.
Endoscopic surgery: Your doctor makes one small incision in the wrist, or one small incision in the wrist and one in the palm. He or she puts a lighted tube—called an endoscope, or scope—into the incision. Surgical tools are put in along with the scope.

See pictures of open carpal tunnel surgery and endoscopic carpal tunnel surgery .

You may decide to have surgery if you've had very bad symptoms for a long time and other treatments haven't helped.

Sometimes surgery is needed to prevent lasting nerve damage. You will likely have a nerve test to see if you need surgery.

How well does surgery work?

Most people who have surgery for carpal tunnel syndrome have less or no pain and numbness in their hand after surgery.

About 70 out of 100 people who have surgery for carpal tunnel syndrome are satisfied with the results. This means that 30 out of 100 people aren't happy with the results. Up to 90 out of 100 people have no pain at night after surgery. So 10 out of 100 people still have some pain at night.¹

Both types of surgery—open and endoscopic—work equally well to improve symptoms.² Talk to your doctor about which surgery might be best for you.

Major problems from surgery can happen, but they are rare. About 1 person out of 100 has a major problem after surgery, such as nerve damage, while 99 out of 100 people don't.²

Surgery compared to a wrist splint

Research suggests that for people with severe symptoms, open carpal tunnel surgery gives more relief to more people than wearing a wrist splint at night for 6 weeks. In one study:³

At 18 months after treatment, 90 out of 100 people who had surgery and 75 out of 100 people who had splints said treatment relieved their symptoms. So 10 out of 100 who had surgery and 25 out of 100 who had a splint still had symptoms.
At 18 months after treatment, 41 out of 100 people who tried splint therapy had since chosen to have surgery, while 59 out of 100 didn't choose surgery.

What can you do other than have surgery?

You can try several home treatments to help relieve your symptoms. This may be all you need to do for mild symptoms of carpal tunnel syndrome. Doctors suggest that you try these treatments for 3 to 12 months before you think about having surgery. It often helps to try several treatments at the same time.

You may try to:

Rest your hand for 1 or 2 weeks. Stop activities that hurt.
Put ice on the palm of your hand and wrist for 10 to 15 minutes at a time.
Take nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, to help your pain. Talk to your doctor before taking NSAIDs. They can cause side effects.
Change the way you do certain hand motions.
Wear a wrist splint. It's usually worn at night, but you can wear it during the day.

Other choices

You can work with a physical therapist to learn how to do activities in a new way.
If these home care treatments don't help, you may be able to take corticosteroid shots or pills to improve your symptoms.
You can try yoga.
Symptoms of carpal tunnel syndrome in pregnant women often go away after childbirth. Unless your symptoms are very bad, you may want to put off having surgery and see if your symptoms go away after you have the baby.

How well do other treatments help symptoms?

Rest, ice, wrist splints, and other home treatments may be all you need if you've had mild symptoms for a short time.

Studies show that:

If you have very bad symptoms, a splint may not help your pain as well as surgery could. In one study, 90 out of 100 people who had surgery said the treatment got rid of their symptoms, while 75 out of 100 people who wore a wrist splint said that treatment got rid of their symptoms. This means that 10 out of 100 people who had surgery said their symptoms didn't get better, while 25 out of 100 who wore a splint said their symptoms didn't get better.³
Corticosteroid shots and pills give short-term relief from symptoms.⁴

Why might your doctor recommend surgery for carpal tunnel syndrome?

Your doctor might recommend surgery if:

You've had very bad symptoms for a long time, so you're at risk of having lasting nerve damage.
Test show that you have nerve damage.
A wrist splint, medicines, and other treatments haven't helped your symptoms.

2. Compare Options

	Have surgery for carpal tunnel syndrome	Try other treatments
What is usually involved?	You have local anesthetic, so you are awake but won't have pain. You go home on the same day. You may wear a splint for several weeks. You need to avoid heavy use of your hand for up to 3 months. You may be able to go back to work after a couple of days if surgery is on the hand you don't use as much. If surgery is on the hand you write with and use most often, it may be 6 to 12 weeks before you can work again after open surgery or 4 weeks after endoscopic surgery.	You can try several home treatments, including: Rest. Ice. A wrist splint. New ways of doing tasks. Yoga. You may get corticosteroid shots or pills. If you are pregnant, you can wait to see if the problem goes away after childbirth.
What are the benefits?	Surgery can make symptoms get better or go away for most people. It can prevent lasting nerve damage.	You don't have the risks of surgery. You may not have to take time off from work.
What are the risks and side effects?	Surgery doesn't always help. About 30 out of 100 people who have surgery aren't satisfied with the results.¹ Your symptoms may come back. Major problems from surgery, such as infection or a problem from anesthesia, are rare.	Other treatments might not work. If you have very bad symptoms and wait too long, you could have lasting nerve damage. If used a long time, corticosteroid medicines can have serious side effects, such as bone-thinning and increased chance of infection.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Carpal Tunnel Syndrome.

Personal stories about surgery for carpal tunnel syndrome

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

" One of the most annoying things about my carpal tunnel syndrome is the night pain in my hands. If I don't wear the splints, it wakes me up almost every night. But with the splints, I can get a good night's sleep, and my doctor says that my thumb and hand strength are not too bad. I'm nervous about any kind of surgery, so when my doctor said it would be okay to wait awhile, I said, "Great." If the splints stop working, though, I'll probably be back in my doctor's office! "

— Dave, age 55

" I own a landscaping business, and a few months ago I started having a lot of pain when putting in backyard fences. Then the pain started to wake me up at night and keep me awake. My doctor said I had a classic case of carpal tunnel syndrome. I tried some of the home treatments that she recommended, and the problem didn't get any worse, but it didn't get any better, either. So I went back and asked about surgery. It sounds like the surgery has a good chance of taking care of the problem, so I'm going to give it a try. When you own your own company, it's too expensive to keep missing work. However, I'll have to wait till the slow season because I'll have to take a few weeks' break to recover. "

— Javier, age 46

" I thought for sure that I was going to have to have surgery for my carpal tunnel. I'm an order-taker for a mail-order catalog company, which means I type a lot, and my symptoms were really getting bad. My fingers were numb, so I kept hitting the wrong keys on the keyboard and making errors. The pain was waking me up at night, and it was even starting to hurt during the day. I went to my boss and the human resources manager at work, and together we worked out a job-sharing arrangement that lets me take orders for part of the day and work in the mail room the rest of the day. I am going to see how that helps, along with the exercises and the splints. "

— Catherine, age 40

" When I dropped my third coffee cup in a week, I decided it was time to do something about my hands. I've had this carpal tunnel problem for a couple of years now, and I'm tired of wearing the splints and getting occasional steroid shots in my wrists. My doctor says that whether I have surgery or not is really up to me at this point. I think I'm ready for it. "

— Danitra, age 36

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery

Reasons not to have surgery

I tried other treatments, but my pain is still bad.

I can live with the pain while I give other treatments some more time to work.

More important

Equally important

More important

I don't mind having surgery if it can get rid of my symptoms.

I just don't want to have surgery.

More important

Equally important

More important

I'm not worried about the small chance of problems from surgery.

I don't want to take even a small chance of something going wrong with surgery.

More important

Equally important

More important

I'm afraid of having lasting nerve damage from carpal tunnel syndrome.

I'm not worried that I'll have lasting nerve damage from carpal tunnel syndrome.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. Home treatments may be all I need to get rid of mild symptoms from carpal tunnel syndrome.

True
False
I'm not sure

That's right. Home treatments often work for mild symptoms from carpal tunnel syndrome. You can try rest, ice, and doing tasks in a new way.

2. Surgery may not be a good choice if my symptoms are caused by pregnancy or a health problem.

True
False
I'm not sure

That's right. Symptoms often go away after childbirth or after treatment for the health problem.

3. I have a good chance of improving or getting rid of my symptoms with surgery.

True
False
I'm not sure

That's right. Surgery is likely to improve or get rid of your symptoms. But it doesn't work all the time.

Decide what's next.

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty.

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Katz JM, Simmons BP (2002). Carpal tunnel syndrome. New England Journal of Medicine, 346(23): 1807–1812.
Scholten RJPM, et al. (2007). Surgical treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4).
Gerritsen AAM, et al. (2002). Splinting vs. surgery in the treatment of carpal tunnel syndrome: A randomized controlled trial. JAMA, 288(10): 1245–1251.
Ashworth N (2007). Carpal tunnel syndrome, search date December 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.