Carpal Tunnel Syndrome (CTS) is a common condition caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. Symptoms often include numbness, tingling, weakness, and pain in the hand and fingers. Choosing the right treatment approach—surgery or conservative measures—depends on the severity of the carpal tunnel syndrome, the patient’s lifestyle, and the desired outcomes.
Conservative treatment is typically the first line of defense, especially for mild to moderate cases, focusing on relieving symptoms and preventing further progression of the condition. Wrist splints, often worn at night, help keep the wrist in a neutral position, reducing pressure on the median nerve and are particularly effective for patients whose symptoms occur primarily during sleep.
Adjusting repetitive hand movements, taking frequent breaks, and improving workplace ergonomics can alleviate symptoms, and avoiding activities that exacerbate symptoms is crucial in this approach. Stretching and strengthening exercises can improve wrist flexibility and reduce inflammation, and therapists may recommend nerve-gliding exercises to ease pressure on the median nerve.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections may temporarily reduce inflammation and provide relief, though they are not long-term solutions and work best as part of a broader treatment plan. Acupuncture, yoga, and other holistic approaches have shown promise for some individuals, and while evidence varies, these methods are generally safe and can complement other treatments 1–4.
When conservative treatment fails or symptoms are severe, surgery may be necessary, with the primary goal being to relieve pressure on the median nerve by cutting the transverse carpal ligament, which forms the roof of the carpal tunnel. Open carpal tunnel release, a traditional surgical intervention, involves a small incision in the palm to access and release the ligament, with high success rates. A less invasive option, endoscopic carpal tunnel release, uses smaller incisions and a camera to guide the procedure, offering generally faster recovery times, though with a success rate comparable to open surgery. Post-surgical recovery typically takes a few weeks to a few months, depending on the method and individual factors, and physical therapy is often recommended to regain strength and mobility 5,6.
Conservative treatment methods are best suited for early stage carpal tunnel syndrome or patients who cannot undergo surgery. They are non-invasive, affordable, and have no downtime. However, they may not resolve severe or long-standing cases.
Alternatively, surgery offers a permanent solution for severe CTS but comes with higher costs, potential complications, and longer recovery times. It is usually considered when other treatments fail or when symptoms significantly impair quality of life 7–9.
The decision between surgery and conservative treatment for carpal tunnel syndrome depends on individual circumstances, the severity of symptoms, and the patient’s personal and professional needs. Consulting with a healthcare professional is essential to weigh the benefits and risks of each approach, ensuring the best possible outcome.
References
1. Surgical versus non-surgical treatment for carpal tunnel syndrome. https://www.cochrane.org/CD001552/NEUROMUSC_surgical-versus-non-surgical-treatment-carpal-tunnel-syndrome DOI: 10.1002/14651858.CD001552.pub3.
2. Carlson, H. et al. Current options for nonsurgical management of carpal tunnel syndrome. Int J Clin Rheumtol 5, 129–142 (2010). DOI: 10.2217/IJR.09.63
3. O’Connor, D., Marshall, S. C., Massy‐Westropp, N. & Pitt, V. Non‐surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003, CD003219 (2003). DOI: 10.1002/14651858.CD003219
4. How to Treat Carpal Tunnel Syndrome Without Surgery | The Hand Society. https://www.assh.org/handcare/blog/how-to-treat-carpal-tunnel-syndrome-without-surgery.
5. Contributors, W. E. Surgery for Treating Carpal Tunnel Syndrome. WebMD https://www.webmd.com/pain-management/carpal-tunnel/do-i-need-carpal-tunnel-surgery.
6. After Surgery: Discomforts and Complications | Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/after-surgery-discomforts-and-complications.
7. Lusa, V., Karjalainen, T. V., Pääkkönen, M., Rajamäki, T. J. & Jaatinen, K. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev 1, CD001552 (2024).
8. Donati, D., Boccolari, P. & Tedeschi, R. Manual Therapy vs. Surgery: Which Is Best for Carpal Tunnel Syndrome Relief? Life 14, 1286 (2024). DOI: 10.3390/life14101286
9. Verdugo, R. J., Salinas, R. S., Castillo, J. & Cea, J. G. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev CD001552 (2003) DOI: 10.1002/14651858.CD001552.