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Surgery for carpal tunnel syndrome

Alice A Hunter, MD
Barry P Simmons, MD
Section Editors
Charles E Butler, MD, FACS
Jeremy M Shefner, MD, PhD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Carpal tunnel syndrome (CTS) is a common nerve entrapment disorder manifested by pain, paresthesias, and ultimately muscle wasting of the hand. Appropriate treatment can interrupt the progression of this disorder and avoid the development of permanent disability. Conservative therapy may be sufficient, although many patients require surgery. Surgical treatment may involve open or endoscopic technique. The goal of either approach is to decrease pressure upon the median nerve at the wrist by dividing the transverse carpal ligament and antebrachial fascia.

This topic review will discuss the surgical treatment of CTS. The clinical manifestations, diagnosis, and conservative therapy of this disorder are reviewed elsewhere. (See "Carpal tunnel syndrome: Clinical manifestations and diagnosis" and "Carpal tunnel syndrome: Treatment and prognosis".)


Indications for surgery include persistent numbness and pain, motor dysfunction with diminished grip or pinch grasping, or thenar eminence flattening.

Prior to contemplating surgical carpal tunnel release, one must be sure of the correct diagnosis. Although median nerve entrapment at the wrist is the most common and most well-studied manifestation of CTS, it is often confused with other disorders, such as cervical radiculopathy, thoracic outlet syndrome and pronator syndrome.

The symptoms of carpal tunnel syndrome include numbness and tingling in the hand, especially if confined to the median nerve distribution. The symptoms are often worse at night but can also be present in the daytime in the worker with a provocative job. Symptoms are often worse with driving or holding a book, newspaper, or telephone [1].

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Literature review current through: Nov 2017. | This topic last updated: Apr 12, 2017.
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