For a brief description of Carpal Tunnel Syndrome, read our previous post.
For an outline of what non-surgical treatments are available for Carpal Tunnel Syndrome, read our previous post.
Do I need Conservative (non-surgical) or Surgical Treatment for Carpal Tunnel Syndrome?
Treatment recommendations for carpal tunnel syndrome are based on several factors including symptom severity, duration of symptoms, evidence of nerve damage, presence of other medical conditions, and whether other non-surgical treatments have worked.
One useful research paper entitled Predictive factors in the non-surgical treatment of carpal tunnel syndrome, by Kaplan et al [published in Journal of Hand Surgery (Br.) 1990 Feb; 15(1): 106-8] proposed a way to identify patients that are likely to respond to the medical (non-surgical) management of carpal tunnel syndrome. 331 hands in 229 patients were evaluated in this study. Medical treatment included wrist splints and anti-inflammatory medication. These patients were followed-up for a period of an average of 15.4 months with a minimum of six months in some patients.
The average treatment success rate with this approach was 18.4%. However, when they stratified these patients into groups based on their symptoms and clinical tests, they manage to identify 5 factors that were important in predicting response to non-surgical treatment. These were:
1. Age over 50 years,
2. Duration of symptoms greater than 10 months,
3. Constant paraesthesiae (numbness),
4. Stenosing flexor tenosynovitis, and
5. A Phalen’s test that is positive in less than 30 seconds.
When none of these factors was present, two-thirds (67%) of these patients were cured by medical (non-surgical) therapy. When any one factor was present, only 40% improved. When any 2 factors were present, only 16% of these patients improved and when 3 factors were present, those 7% of those patients improved. When a patient had four or five of these factors present, none of them were cured by medical management alone!
Simply put – the older you are, the longer you’ve had your symptoms, the more severe those symptoms are, and if you have other tenosynovitis conditions in the hand (e.g. trigger finger), then the less likely you are to improve with non-surgical treatments alone. In these cases, early surgical treatment provides better results and a more complete and rapid recovery.
Surgery decompresses the carpal tunnel, relieves the pressure on the median nerve and prevents the condition from progressing. This prevents permanent damage to the nerve that can sometimes lead to thumb muscle weakness and permanent numbness of the fingers.