“Will I get better after carpal tunnel surgery?”

April 25, 2018 | By: Raleigh Orthopaedic Team

Patients frequently ask me “Will I get better if I have carpal tunnel surgery?  I heard from my co-worker or neighbor that he/she did not get any better after surgery …”.  This can be an awkward question to answer because yes, indeed, the vast majority of patients do get complete relief of their symptoms after carpal tunnel surgery, but no surgeon likes to over-promise results.   On the other hand, we get a lot of gratification when patients’ problems are solved. 


Traumatologist is taking care of the patient
Traumatologist is taking care of the patient

Most patients with carpal tunnel syndrome experience intermittent or even contant pain in their wrists and their hands and numbness and tingling in their thumb, index, middle, and ring fingers.  These symptoms are often most notable when they drive, use a cell phone, or try to sleep.  Often these symptoms can be quite severe and can make it very hard for people to get a good night’s sleep.  Often, we will initially treat these patients with a steroid injection or a splint but, eventually, patients tend to grow tired of wearing a splint or getting steroid injections and often undergo surgery and will get complete relief of their symptoms. 


A smaller subset of patients will present with diminished sensation in their fingers in addition to the painful tingling.  These patients also tend to be very appreciative of their postop relief.  The tingling tends to go away immediately, while the numbness does tend to slowly resolve.  Though they still have numbness in their fingers, their function is much improved because the tingling and pain is gone and typically the numbness also resolves, though it can take up to 6-12 months postoperatively. 


There is also a small subset of patients who do not seem to notice any symptoms until they get fairly profound numbness in their hands.  Often these patients do not have much pain, but the loss of sensation is very annoying and disruptive because they have a hard time manipulating small objects.  The surgical result in these patients is often not as instantly gratifying.  Though surgery is typically these patients’ best option, their sensation may never return to normal and often takes 6-12 months to improve. 


Unfortunately, there is also another small group of patients that do not get complete relief of their symptoms.  These patients typically present in a way that would suggest they would get total relief of their symptoms. For example, one may present with intermittent tingling and numbness in their fingers that is painful.  However, despite surgical treatment, a small proportion of these patients will have persistent symptoms.  This subset typically comprises less than 5% of patients, but are very difficult to predict pre-operatively. These patient often improve with time, but this can be a very frustrating situation for both the patient and the doctor. 


In terms of trying to predict a result from carpal tunnel surgery, sometimes we will order an EMG/nerve conduction velocity test.  This test can be useful not only to confirm the diagnosis of carpal tunnel syndrome, but also to assess the severity of the effect on the nerve.  Generally, there is a correlation with this test and the result:  The worse damage to the nerve, the less reliable is the result of surgery.  However, even when an EMG/NCV test shows “severe” carpal tunnel syndrome, many patients who only have painful tingling in their fingers remain very satisfied with their result. 


Another way that we can sometimes predict a result of carpal tunnel surgery is to perform a preoperative carpal tunnel steroid injection.  Complete relief of carpal tunnel symptoms with a carpal tunnel steroid injection is very reliable at predicting a very good result after carpal tunnel surgery.  The opposite, however, is not always true:  In other words, some patients who do not get good relief after a carpal tunnel steroid injection, still get quite a good results from carpal tunnel surgery. 


In summary, most patients who have carpal tunnel surgery do get a very satisfying result.  I say this based not only on my experience, but also on peer reviewed scientific articles published in our surgical literature such as The Journal of Hand Surgery.  Unfortunately, there are a small subset of patients who do not get complete relief of their symptoms and some of these patients are those who have irreversible nerve damage that we can predict preoperatively.  Thus, understanding patients’ pre-op symptoms, as well as understanding the severity of the nerve damage preoperatively, does give us some ability to counsel patients on the expected result. 


Harrison Tuttle, M.D.

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