The tingling and numbness that accompanies carpal tunnel syndrome may start gradually and be only mildly annoying, but it can progress to debilitating pain or weakness, sometimes despite taking steps to alleviate it.

But how do you know when it's time to consider carpal tunnel surgery?

"Carpal tunnel syndrome occurs when your median nerve — which runs down your forearm and into your hand, where it helps provide sensation and muscle movement in the palm side of some of your fingers — becomes compressed as it travels through a passageway in your wrist called the carpal tunnel," says Dr. Jamie Alexander, a hand orthopedic surgeon at Houston Methodist. "This can lead to uncomfortable symptoms felt in the arm, hand, wrist and fingers and potentially even permanent nerve damage in severe cases."

A person can have carpal tunnel syndrome in both hands or just one, either the dominant hand or the non-dominant one. And the symptoms can range from mild to severe and be felt only now and then or more often than not.

"There's a lot of variety in how carpal tunnel syndrome presents from person to person, so it's important to be evaluated so you can understand what the best course of action is for your specific situation," says Dr. Alexander.

What carpal tunnel syndrome treatment options are available?

"The first step to treating carpal tunnel syndrome is to use electromyography (EMG) and neuroconductive testing to determine the severity of the syndrome and whether there's compression elsewhere," says Dr. Alexander.

These tests help determine the appropriate treatment, both the conservative course to be followed initially but also possible other options if more aggressive steps ultimately need to be taken.

For instance, if carpal tunnel syndrome is mild, initial treatment may include wrist splinting, anti-inflammatory medications and occupational therapy. Corticosteroid injections may be recommended for temporary symptomatic relief.

"If the condition appears severe or if the patient is having significant symptoms, that's when we start to consider surgery," says Dr. Alexander.

Why have carpal tunnel surgery?

Left untreated, severe carpal tunnel syndrome can lead to permanent nerve damage.

"If your symptoms are getting worse or aren't improving with treatment, it's important to let your doctor know," explains Dr. Alexander. "Carpal tunnel syndrome can progress and become severe, potentially leading to loss of dexterity, sensation, and fine motor skills."

Dr. Alexander says it's time to consider surgery when conservative approaches aren't enough or if the severity is a concern.

"If your pain is continuous and has progressed to the point that it's interrupting your everyday life, it's likely time for surgery," explains Dr. Alexander. "Of course, we may also recommend surgery if your clinical exam or test results indicate that we need to intervene before your condition get worse."

What is carpal tunnel surgery?

"During carpal tunnel surgery, pressure on the median nerve is relieved by cutting the transverse carpal tunnel ligament, which essentially releases the ligament so that the passageway is more open and there is more room for the median nerve," says Dr. Alexander. "This is why the surgery is also sometimes called carpal tunnel release."

There are two ways carpal tunnel surgery is performed:

• Endoscopic surgery – also referred to as minimally invasive surgery, it uses one or two small incisions and a tiny camera to guide surgical tools to the carpal ligament and cut it
• Open surgery – it uses an incision made along the palm side of the wrist to access and cut the carpal ligament
  
  

"Which surgical option is best for you typically depends," explains Dr. Alexander. "Some people simply prefer one over the other. In some cases, the severity of your condition may make the decision for you, since open surgery is sometimes required to see if there is something else in the tunnel compressing the median nerve."

What to expect during carpal tunnel surgery recovery?

Immediately after the procedure, it's important to keep the incision clean and dry for two weeks. It's also important to restrict heavy lifting.

The timetable for post-surgery recovery can vary, depending on the severity of your condition, how smoothly the healing process goes and how well you rehabilitate your hand.

"Finger flexibility is key for recovery after carpal tunnel surgery," says Dr. Alexander. "Whether typing on a keyboard, or just trying to make a fist, you want to get your fingers moving."

She adds that swelling can slow your recovery so let your doctor know if your post-surgery swelling seems excessive or lasts longer than expected.

"Some people experience relief as soon as a few weeks to months after carpal tunnel surgery, especially for the night-time symptoms," says Dr. Alexander. "However, it can take up to a year to see complete improvement."