Carpal Tunnel Surgery Problems

Every year in the United States, more than 500,000 people undergo carpal tunnel release surgery in an effort to relieve pain caused by carpal tunnel syndrome (CTS). While surgery is typically effective, there is no guarantee that it will alleviate symptoms or that the symptoms will not return later. Because problems may arise as a result of this type of procedure, it is important to understand the risks before deciding to go this route.

Carpal Tunnel Syndrome

• The carpal tunnel is a passageway in the wrist through which the median nerve and nine tendons travel to the hand. When space in the tunnel is decreased, compression of the median nerve can occur, causing pain, tingling and numbness in the hand. Symptoms begin as a gradual ache and progressively worsen over time. Early treatment includes anti-inflammatory medication, corticosteroid shots, wrist splints and physical therapy. Surgery may be recommended if symptoms do not improve from this conservative approach, or if there is continual numbness, symptoms have occurred for over 10 months, or the palm muscle has deteriorated.

Surgery

• Several types of surgery are available to relieve carpal tunnel syndrome. All are out-patient procedures and involve the cutting of the transverse carpal ligament to decrease pressure on the median nerve. In an open release surgery, an incision is made from the wrist to the palm of the hand. It is argued that because this approach gives the surgeon a better view of the area, there is less risk of a cut to the nerve. However, recovery time and scarring are increased with this procedure. Mini-open release is a similar surgery, but the incision is only about an inch in length. Endoscopy is a procedure in which one or two 1/2-inch cuts are made and thin tubes with a camera and knife are guided into the carpal tunnel. The surgeon makes the cut while viewing the area on a monitor. This type of surgery is less invasive and equally effective.

Minor Risks

• Complications from carpal tunnel surgery rarely occur, but as with any surgery, there are always some risks to consider. Possible problems, usually temporary, include bleeding, pain, stiffness and an allergic reaction to medication. Minor infection may also occur that can be treated with antibiotics. There is typically a temporary decrease in strength that affects gripping and pinching ability. The most common problem, however, is the return of symptoms.

Serious Complications

• There are very few major risks associated with carpal tunnel surgery. Because the median nerve lies directly beneath the transverse carpal ligament, there is a possibility that the nerve may be nicked, cut or even severed. Sensory nerve damage may result in permanent numbness, while motor nerve damage can severely inhibit hand movement and strength. Nerve damage is rare, occurring in only 1 out of every 100 carpal tunnel surgeries. There is also a chance that major infection can occur, making another surgery necessary. Additionally, it is theorized that carpal tunnel surgery may increase the possibility of patients developing arthritis, although there is no conclusive research to support this concern.

Effectiveness

• Carpal tunnel release is believed to be the most effective treatment for CTS, but not all patients experience an improvement of symptoms post-surgery. About 70 percent of patients report being satisfied with the outcome of surgery, and around 90 percent no longer have symptoms at night. In some cases, pain is reportedly the same as or worse than before the release procedure. Scar tissue build-up in the wound and inadequate resting of the hand during the recovery process can increase the likelihood that symptoms will return.