Carpal Tunnel Syndrome (CTS) is caused by tight bands in the palm of the hand and wrist that put pressure on the median nerve - a nerve that runs down the arm and forearm. Most people with CTS experience aching pain and/or numbness and sometime weakness in their hands and fingers. Carpal tunnel surgery involves making one or two small incisions over the palm of the hand to gently cut the bands that are putting pressure on the median nerve. Two techniques can be used to perform the surgery:

• Endoscopic surgery - using a small camera attached to a monitor which requires two incisions each about one-half inch long.
• Open procedure - uses a single incision about two to three inches long. The incisions are made to see and then gently cut the tight bands in the hand that are putting pressure on the M\median nerve. The nerve runs right beneath the bands. By cutting the tight bands the pressure on the nerve is relieved and usually the pain and numbness improve.

In addition, some surgeons will remove swollen or irritated tissue surrounding the nerve.

Non-surgical treatments such as anti-inflammatory pills, wrist splints, or steroids are usually recommended first if you are suffering from symptoms of CTS.

If all non-surgical treatments are unsuccessful, your surgeon will test the electrical activity of the median nerve through a test called an EMG. If the results of the test are consistent with CTS, carpal tunnel release surgery is an option.

Each type of surgery (endoscopic or open) has risks and benefits. Either technique may be right for you. In general, the endoscopic procedure has a slightly faster recovery, but the open technique has slightly less risk of nerve damage. The results of carpal tunnel release surgery are generally very good.

Alternatives to surgery include the following:

• Medications - Some medications can provide relief of symptoms:
  • Non-steroidal anti-inflammatory drugs (also called NSAIDs), such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity.
  • Diuretics are water pills that can decrease swelling.
  • Steroids such as Celestone, triamcinolone, depomedrol, etc. can be injected directly into the wrist or taken by mouth (prednisone) to relieve pressure on the median nerve and will sometimes provide relief to persons with mild and/or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of steroids can make it difficult to regulate insulin levels. Steroids should not be taken without a doctor's prescription).
  • Vitamin B6 (pyridoxine) supplements may ease the symptoms of CTS. Some studies have shown effectiveness.
• Wrist splints - Splints help position the wrists to take pressure off the median nerve and are often very helpful in treating mild CTS. Often they are worn only at night. Your doctor can arrange the appropriate type of splint and explain how to use the splint effectively.
• Workplace modification - Changes to how you work including the way you sit or use the keyboard can significantly improve symptoms from CTS. Your doctor and physical therapist can help guide these modifications and often larger employers will have programs within the company to help improve your workplace practices.
• Exercise - Stretching and strengthening exercises can be helpful in people whose symptoms are mild or have improved. A physical therapist or occupational therapist (a hand therapist) can prescribe specific exercises that will help.
• Alternative treatments - Some patients have benefited from acupuncture and chiropractic care though the effectiveness of these options have not shown definitive results. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.

No special preparation is needed for the procedure. Usually your doctor will have you stop eating and drinking at midnight on the evening before the day of surgery.

You will most likely be awake or mildly sedated during the surgery and your arm will be numbed. You will go home within two to three hours after the surgery is completed. The skin incisions usually heal within three to six weeks, but final recovery of any pre-existing nerve damage can take anywhere from several weeks to a year, depending on the severity of the damage. The nerve may not completely recover depending on how badly it was damaged prior to surgery. However, most patients demonstrate significant improvement in nerve function recover completely. The longer the symptoms lasted before surgery and the more severely damaged the nerve appears at surgery, the longer the recovery time.

A splint may be used to reduce wrist motion for the first few days after surgery and this must be worn as long as your doctor recommends it to avoid complications. Range of motion should not be delayed for too long because the wrist can become stiff.

A variety of factors may influence the cost of the surgery. They include:

• Insurance coverage
• Pre-existing health
• Insurance co-pay
• Location of the facility

These factors vary depending on you and your situation.

The cost of each procedure can vary dramatically based upon age, location, gender, and insurance coverage. HealthGrades provides detailed cost estimates which include the costs of the procedure, drugs, hospital stay, and more. Each cost estimate is easy to understand and provides medical terms you need to know.

The detailed cost estimate for Carpal Tunnel Release Surgery, includes costs for:

• Endoscopic carpal tunnel surgery, and open carpal tunnel surgery.