Carpal Tunnel Syndrome - Surgery

Factors that may reduce the chances for success:

Being elderly. (Although a recent report indicated that overall, 83% of patients over 65 years of age were either completely satisfied or very satisfied with their surgical outcome.)
Having very severe preoperative symptoms.
Being involved with very heavy manual labor, particularly working with vibrating tools. (In some studies, only slightly more than half the people who used vibrating hand-held tools were symptom-free three years after their operations.
Having very poor nerve conduction results before surgery. (It should be noted that some patients with severe symptoms but who have normal neurologic and physical test results can still experience significant relief from CTS surgeries.)
Being on hemodialysis. (Such patients have good initial success but about half deteriorate in about a year and a half.)
Alcohol abuse.
Having poor mental health.
Diabetes and high blood pressure. Patients with these conditions may also be more likely to require a second operation.

Factors that make no difference in results:

Patients whose CTS is due to nerve damage from medical conditions, such as diabetes, rheumatoid arthritis, or hypothyroidism. Such patients appear to have the same outcome as those without such conditions and so such disorders should not preclude them from surgery.

Standard Release Surgical Procedures

Open Release Surgery. Traditionally, surgery for CTS entails an open surgical procedure performed in an outpatient facility. The surgery is straightforward:

A local anesthetic is injected either into the wrist and hand or higher up the arm. This injection can be very painful for some people. Applying an anesthetic cream before the injection can reduce the pain.
The surgeon makes a two-inch incision in the palm. In some cases, the incision must be extended into the forearm.
The surgeon makes further incisions in the muscles of the hand until the carpal ligament is visible.
The carpal ligament is then cut free from the underlying median nerve. The ligament is literally released and, therefore, the pressure on the median nerve is relieved. Sometimes the lining of nearby tendons is also pared (called flexor tenosynovectomy), but one study showed no benefits from this additional step.

In treating carpal tunnel syndrome, surgery may be required to release the compressed median nerve. The open release procedure involves simply cutting the transverse carpal ligament.

The Mini-Open Approach. In recent years, more surgeons have adopted a "mini" open--also called short-incision--procedure. It uses only a one-inch incision, but it still allows a direct view of the area (unlike endoscopy, which is viewed on a monitor). The mini-open approach may allow for quicker recovery while avoiding some of the complications of endoscopy, although few well-connected studies have been conducted on its benefits and risks. In a 2005 report, the mini-open approach was directly compared with open release surgery. The recovery time in patients receiving the mini-open approach was shorter than with the open approach and results were about the same 30 months after the surgery.