When is the right time to have carpal tunnel surgery?
This is a common question I hear from my patients. Surgery is a daunting prospect for anyone, and taking that first step by consulting with a Surgeon can be quite difficult. It may feel like you don’t have any other option but to have an operation, but this may not necessarily be the case. Some patients may be better managed with splints, Hand therapy or even targeted cortisone injections.
Carpal tunnel syndrome is a result of compression of the main nerve to the hand (median nerve) that gives sensation and function to the thumb, index, middle and half the ring finger. Hence if it is left untreated for too long, it can have devastating consequences for hand function. Symptoms may be mild in the beginning, with numbness and tingling at night or first thing in the morning. If they settle quickly then it is a good sign that the nerve is able to recover. However once you start having numbness or tingling at rest, or all the time, then it is likely the nerve is already damaged. Nerve fibres can recover if decompressed at this stage, but the recovery is slow and can take many months. Unfortunately, many patients leave it until they are at this late stage before seeking treatment for their carpal tunnel symptoms. By then the non surgical treatment options would no longer be effective, and surgery is definitely indicated.
Surgery is invasive. No matter how careful we are, even if it is “minimally invasive”, “key-hole” or “robotic” surgery, it is still trauma to tissues and structures within the body. Having said that, with the advances in modern technology, our ability to minimise impact on normal tissue is becoming better and better. So when it comes time to have your carpal tunnel released, it can be performed through minimally invasive techniques which can help speed up your functional recovery. There is good evidence that endoscopic (key-hole) carpal tunnel surgery can lead to quicker return to work and driving than the traditional open approach. This is especially true for bilateral surgery.
When is the right time to have surgery? Perhaps a better question is when is the right time to see a Surgeon? The simple answer is, now! Because your Surgeon may not necessarily treat you with an operation, but she or he would likely give you the proper advice on the treatment that is best for your stage of compression.
