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I'm thinking about having surgery for carpal tunnel syndrome. I just can't decide if I should do it or not. What's your best advice?

When it comes to carpal tunnel syndrome, most hand surgeons tell their patients to be patient. Six weeks to six months of conservative (nonoperative) care is advised first. Antiinflammatory and/or pain relieving drugs may be prescribed. Referral to a physical or occupational therapist is a good idea.

A hand therapist will examine you and use treatment to alter the soft tissue structures around the nerve. Releasing the nerve and/or taking pressure off the affected nerve(s) can go a long way in reducing pain, numbness, and tingling that can be very disabling.

Special nerve mobilization techniques developed in the last 10 years are often very helpful. Stretching and gliding exercises restore full motion of the nerve. This is especially helpful if it has been bound down by adhesions or other connective tissue.

Two groups of patients are not usually good candidates for carpal tunnel release. The first show signs of advanced nerve damage. Muscle wasting called atrophy and weakness are present. Loss of sensation in the fingers and hand also signal more severe nerve damage. Surgery isn't likely to change these symptoms.

The second group has pain but normal electrodiagnostic tests. This group is most likely to obtain relief from their symptoms with conservative care. Studies show that other factors can also affect the outcomes of carpal tunnel release. These include depression, litigation, and psychosocial factors.

If any of these situations describes you, consider a course of conservative care and discuss your concerns with your surgeon. Give yourself time to sort through all the factors and try some nonsurgical options. If you do have surgery, many surgeons commonly use newer, less invasive methods. There are fewer side effects and good relief of painful symptoms. Patient satisfaction with the results is very good.

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