Depending on the symptoms, carpal tunnel syndrome (CTS) can be treated with conservative therapy or surgery may be necessary.
If the symptoms and electrophysiological changes are only minor, conservative therapy can be carried out without surgery. The wrist is immobilized in a cuff and anti-inflammatory medication is administered. A cortisone injection into the carpal tunnel can provide good relief, particularly in the case of CTS during pregnancy.
If conservative treatment is of no use, or if there are already pronounced sensory disturbances, muscle atrophy and/or a significant deterioration in the nerve’s conduction capacity, surgery is necessary. During this procedure, the ligament that spans the carpal tunnel on the front of the hand is severed. This creates more space for the tendons and nerves. The operation can be performed via a small incision in the palm of the hand (mini-open) or under camera view (endoscopic) via a small incision in the crease of the wrist. Both methods are comparable in terms of the surgical result. The advantage of the endoscopic method is that there is no incision in the loaded palm of the hand. Both procedures can be performed under local anesthesia on an outpatient basis.
A dressing is applied immediately after the operation and is left in place until the first wound check 2-3 days later. A protective bandage is then worn until the stitches are removed. During the first two weeks, the hand must be protected and no heavy objects such as pans, shopping bags etc. may be carried. After two weeks, the load can be slowly increased within the pain threshold. Full weight bearing is usually possible after 4-6 weeks. If necessary, supportive hand therapy can be arranged to improve mobility, strength and scar care.
The prognosis depends on the damage to the nerve at the time of the operation. If there is no permanent damage, sensitivity and strength can fully recover. However, this can take several weeks to months. In the case of prolonged compression with permanent damage to the nerve, the symptoms will not recover completely.
Occasionally, even after a successful operation, scar tissue, for example, can again cause a narrowing in the area of the carpal canal and a constriction of the nerve. In the case of a repeat operation, a larger incision is required across the wrist so that the nerve can be carefully freed from scarring and adhesions. Accordingly, the recovery time after these operations is longer than with primary surgery.
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