When the pain, tingling and numbness of carpal tunnel syndrome make everyday tasks like texting or gripping your steering wheel difficult, your doctor may recommend hand surgery to prevent permanent nerve damage.

Dr. Derek Bernstein

A minimally invasive surgical procedure called endoscopic carpal tunnel release is increasingly becoming the treatment of choice, because it is effective and patients recover fast. Dr. Derek Bernstein of Novant Health Orthopedics & Sports Medicine in Winston-Salem performs hundreds of these surgeries every year.

“Patients can sometimes be hesitant to address carpal tunnel syndrome because they have busy lives and worry about taking an extended recovery period after surgery,” he said. “While everyone recovers differently after treatment, if you feel comfortable after endoscopic surgery, I will allow you to go back to all of your activities as soon as the next day.”

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Bernstein recently performed endoscopic carpal tunnel release on a mother of two. She had surgery on both hands, six days apart. Both times, she returned to her demanding skilled-trade job the next day. Another patient had both wrists treated over the Christmas holiday – and was back on the golf course within days.

Bernstein shares what you need to know about carpal tunnel syndrome and surgical treatment.

About the carpal tunnel: It is a narrow opening at the wrist made up of bone at its floor and side walls with a ligament at its roof. The median nerve travels through this canal, providing feeling to the thumb, index, middle and ring fingers. The tendons that flex the fingers are also found within the carpal tunnel. Over time, the space can become tighter, damaging the median nerve.

Causes of carpal tunnel syndrome: When the median nerve gets compressed at the wrist, pain, numbness, tingling and burning may result. The thumb, index, middle and ring fingers are most often affected. While any healthy person can develop carpal tunnel syndrome, risk factors include injury, diabetes, rheumatoid arthritis, thyroid problems and even pregnancy and menopause. Carpal tunnel syndrome has also been linked to repetitive hand motions as in knitting, golfing, carpentry, keyboarding or assembly line work.

More information

  • More than 600,000 carpal tunnel surgeries a year are performed in the United States.
  • Carpal tunnel syndrome is three times more common in women than in men.
  • It tends to run in families — if you have a parent or sibling with carpal tunnel syndrome, you're more likely to develop it.
  • Endoscopic carpal tunnel release was introduced in 1987.
  • A research review published in 2019 found that endoscopic and open carpal tunnel release surgery are "comparably safe and equally effective."

SOURCES: National Library of Medicine, Current Reviews in Musculoskeletal Medicine

How it progresses: You may notice it first in either hand, and it can spread to both. Sleeping at night with the wrists bent may worsen symptoms, and waking up with numbness or pain is a possible sign of significant nerve damage. As symptoms worsen, your fingers may feel swollen when they’re not, and you may have trouble grasping or holding small objects.

When surgery is indicated: When pain relievers, anti-inflammatories, steroid shots and wrist splints don’t provide relief and a patient has worsening symptoms, surgery at the carpal tunnel to take pressure off the media nerve may be necessary.

“In a lot of ways, it’s similar to parking your car on a garden hose – when this happens, the hose doesn’t shoot out water as quickly or as strongly,” Bernstein said. “When you have compression of the median nerve, it may become damaged and does not fire its signals as quickly and as strongly. Over time, if not adequately treated, that compression can progress to permanent nerve damage.”

The goal of treatment is to prevent this.

About carpal tunnel release surgery: Novant Health offers two procedures for patients who have not had prior carpal tunnel surgery – traditional open carpal tunnel release and endoscopic carpal tunnel release. Revision surgery is also offered for appropriate patients with persistent or recurrent symptoms after prior carpal tunnel release.

In open carpal tunnel release, a 1- to 2-inch-long vertical incision is made at the base of the palm to release the ligament that forms the roof of the carpal tunnel. Since the incision is located in the weight-bearing portion of the palm, most patients are advised to keep it covered until stitches are removed 10 to 14 days after surgery. They are also advised not to lift anything over 10 pounds for a month so as not to split the incision open.

In endoscopic carpal tunnel release, the surgeon makes a smaller, quarter-inch horizontal incision in the crease of the wrist to release the carpal tunnel. No incision in the hand is needed, and dissolvable stitches are used. Typically, patients have a soft, dry dressing for two to three days and are allowed to resume most normal activities, a day or two later.

“It is a less invasive option that allows for a faster functional recovery,” Bernstein said.

Results to expect: Both procedures can successfully release the carpal tunnel with similar long-term results. Endoscopic carpal tunnel surgery has three potential advantages: It is typically less painful. The incision is smaller and stays out of the weight-bearing surface of the palm. And patients can resume regular activities sooner.

Deciding which procedure is right for you: You and your surgeon will discuss the pros and cons of each procedure, how they relate to your individual health, as well as your personal goals. During this conversation, you should definitely ask any questions you have and seek clarification if anything is unclear so you are comfortable with your choice.