Most patients who come to see us about carpal tunnel are worried about the same things: do I need surgery, how much time will I miss, and will it actually get better? The honest answers are: maybe not, probably not much, and usually yes — but let’s talk about what that depends on.
Do you need surgery?
Not necessarily, and we won’t push you toward it. Our approach is straightforward: surgery becomes the right answer when two conditions are met — your symptoms are no longer tolerable, or the nerve is showing signs that waiting is no longer safe. Until then, there are good reasons to try other approaches first.
What does "waiting too long" actually mean?
The carpal tunnel is a tight space, and when the nerve running through it stays compressed long enough, it stops getting adequate blood flow. Think of it like squeezing the blood out of a sponge — if you hold it long enough, the sponge itself can be damaged, and releasing the pressure doesn’t fully restore it. When that happens, some nerve fibers can be permanently lost, and even a successful surgery may not bring full feeling or strength back.
So how do you know if you’re approaching that point? Three things concern us: symptoms that are constant rather than intermittent (the nerve isn’t getting a break), weakness in the hand, and numbness that has become persistent rather than coming and going. If any of those are present, we’ll have a more direct conversation about timing.
How do we evaluate it?
We’ll talk through your symptoms and examine your hand, and in most cases we’ll order a nerve conduction study (EDX). This test measures two things: how fast signals travel along the nerve (a measure of the insulating layer around the nerve fibers) and how strong those signals are (a measure of the fibers themselves). Based on your symptoms, we can often predict what the test will show before it comes back — and we’ll walk you through what the results mean for your options.
Non-surgical treatment
For patients whose symptoms are manageable and whose nerve still has full recovery potential, we typically start with a night splint and nerve flossing exercises. The splint keeps your wrist in a neutral position while you sleep — because many people unconsciously curl their wrists at night, which compresses the nerve during the hours it would otherwise have a chance to recover. Nerve flossing is a gentle exercise that helps maximize the space available to the nerve as it moves through the tunnel.
We use injections selectively — occasionally to calm a flare or to help confirm the diagnosis when there’s uncertainty.
If surgery is the right answer
We recommend surgery when symptoms are no longer tolerable and we’re confident in the diagnosis, or when the nerve tests show it’s trending in the wrong direction. If you’d prefer to wait, we’ll recheck the nerve study in 9-12 months. If things are progressing, we’ll recommend moving forward at that point.
The surgery itself is straightforward. Stitches come out at 10 days. Pain is managed with Tylenol and ibuprofen. There are no formal activity restrictions — patients naturally protect the hand themselves in the early days. Most people are well on their way within two weeks. For those who need a little more help, we’ll refer to hand therapy.
One honest note: nerve recovery takes time. The surgery removes the cause of compression, but the nerve itself heals slowly. Improvement in sensation and strength can continue for months after the procedure, and patients with more advanced nerve damage going in should expect a longer and sometimes incomplete recovery — which is one reason we don’t like to wait too long.
Scheduling An Appointment
When you schedule an appointment, you need to fill out a new patient packet. This will include both the administrative paperwork and a section to describe your health history and the problem you are experiencing. You can download it below.