Can Carpal Tunnel Recur After Surgery?

Carpal tunnel syndrome (CTS) is a common problem that impacts around 4 to 10 million Americans. Most people first experience symptoms between the ages of 40 and 50, and women are three times more likely to have CTS than men. Fortunately, there is a surgical treatment that can resolve the symptoms of CTS. Carpal tunnel surgery has a high success rate, estimated between 75% and 95%.

Understanding CTS

The carpal tunnel is a narrow passageway about an inch wide running down the palm side of the wrist. The carpal bones form the upper side of the tunnel, while the transverse carpal ligament runs along the underside. This passage contains the median nerve and flexor tendons. As it reaches the hand, the median nerve separates into several smaller nerves that provide feeling to the thumb, index finger, middle finger, and part of the ring finger. The tendons running through the carpal tunnel control the flexing of the fingers and thumb.

CTS arises when something compresses or irritates the carpal tunnel. Compression or irritation can occur due to repetitive wrist movement, wrist sprains or fractures, or ganglion cysts. Conditions such as arthritis, diabetes, pregnancy, or thyroid imbalances can also contribute to swelling and pressure along the carpal tunnel. Symptoms include:

• Numbness, tingling, burning, or pain in the fingers and hand that may travel up the wrist and arm
• Sudden sharp pains in the thumb, index, middle, or ring fingers
• Weakness in the hand, particularly in the pinching motion of the thumb

Carpal Tunnel Surgery: A Brief Overview

Between 31% and 40% of people with CTS choose to get surgery for the condition. Carpal tunnel surgery involves cutting through the carpal ligament to relieve pressure on the tunnel. The ligament may grow back together, but it typically lengthens when it does, providing a more spacious tunnel that doesn’t compress the nerves and tendons. Your surgeon may approach the surgery using one of two methods:

• Open carpal tunnel release: The surgeon makes an incision on the palm side of the hand to expose the ligament.
• Endoscopic carpal tunnel release: The surgeon makes one or two smaller incisions and uses a small camera known as an endoscope to view the ligament while cutting.
• Ultrasound-guided tunnel release: The surgeon uses non-invasive ultrasound to view the arteries, tendons, ligament, and nerve and cuts the ligament with a small blade or through a wire-guided needle.

Potential for Recurrence After Surgery

There is a 5%-10% chance of recurrence after carpal tunnel surgery. Recurrence may happen because of an incomplete release in the initial surgery. Scarring or adhesions at the surgical site can also compress the carpal tunnel and cause a recurrence. Recurrent CTS is more likely in patients with comorbidities, such as:

• Diabetes
• Hypothyroidism
• Rheumatoid arthritis
• Obesity
• Cervical spine problems

Detecting the Return of CTS

It’s difficult to initially detect the return of CTS because the symptoms may persist for weeks or months after surgery. Patients with mild symptoms may experience immediate relief after carpal tunnel surgery. Minor soreness at the incision site can last a few weeks as the skin heals. Patients typically regain their grip and pinch strength and experience relief from tingling and numbness within two to three months of surgery. Those with extreme symptoms before surgery may not get complete relief or restoration of their grip strength for six to 12 months.

Stay in touch with your surgeon throughout the recovery process so they can monitor your progress. If symptoms don’t gradually improve or if they worsen, you may need to explore further treatment options.

Preventing Recurrence: Tips and Strategies

You should complete all physical therapy exercises that your health care team prescribes to ensure optimal recovery from CTS surgery. Wrist extension and wrist flexion stretches should help speed your recovery and prevent stiffness or recurrence of your carpal tunnel. You can also work with an occupational therapist who can massage the soft tissue around the sutures to reduce swelling and discomfort.

You will also need to give your wrists regular breaks for recovery post-surgery. Stop repetitive movement of the hands and wrists for 10 to 15 minutes every hour. Perform gentle stretches during this time. Use an ergonomic keyboard or wrist rest at your mouse to support your wrists and avoid excess pressure on the median nerve.

Treatment Options for Recurrent CTS

If your CTS recurs because of an incomplete release, a subsequent surgery to complete the release should resolve your symptoms. If the CTS returns as the result of scarring or adhesions at the surgical site, a skilled microsurgeon can perform a second surgery to release the nerve from the scar tissue. The surgeon will then use synthetic nerve wraps or muscle flaps to create a barrier around the nerve to prevent future scarring.

If your CTS was severe before the surgery, you may experience persistent symptoms even without scar tissue or an incomplete release. In this case, you may want to explore nonsurgical treatments, such as:

• Wearing a wrist splint at night
• Using corticosteroid injections
• Modifying your posture or ergonomic setup during your routine activities
• Engaging in prolonged physical therapy

Managing Expectations: Life After Carpal Tunnel Surgery

Keep in mind that it typically takes at least two months to recover from carpal tunnel surgery completely. You may need to use a wrist splint or brace during this time. Your surgeon will typically follow up after six weeks to review your progress and make further recommendations. The first thing you will notice is relief from nighttime pain and discomfort. Patients often notice that pain and tingling sensations resolve before their grip strength returns.

Get Expert Help for Your CTS

If you’re suffering from wrist pain and discomfort, our experts at The Hand and Wrist Institute can help. We can diagnose and provide treatment options for a variety of wrist conditions, including carpal tunnel syndrome. Contact us today to make your appointment.

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Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.