The purpose of CTS surgery is to relieve the symptoms that produces pressure on the median nerve and carpal tunnel.

For purposes of this Supervised Writing Project CD-ROM, there are two types of CTS surgery:

Click on either surgery graphic for individual surgery information.

Endoscopic

Open Tunnel

Endoscopic: This is the latest and greatest in CTS microsurgery. Instead of cutting the transverse carpal ligament wide open with a “broad stroke” as it were, the surgeon makes a thin cut across said ligament.

The key difference between Endo and Open Tunnel Surgery operations is the size of the incision. Endo's incision is smaller than that of Open Tunnel Surgery which arguably means faster and shorter recovery time for the former than the latter since there is less of a surgical cut to heal.

Caveat emptor: What the surgeons don't tell you is that once the transverse carpal ligament is cut, the hand substantially loses its remaining ability to grab and manipulate things. This is worse than just dropping things before the surgery is done. One can't grip anything to drop it!

But, as surgeons will tell you, at least the pressure is off of the carpal tunnel! [Does the term “shortsighted” have any relevance here?]

Yes, it arguably may be possible to “reconstruct” the surgically-cut transverse carpal ligament. However, when the inevitable scar tissue forms, it produces pressure on the carpal tunnel and median nerve again. Also, if one resumes the type of repetitive activity that caused his/her RSI(s) initially, the RSIs will return regardless of the previous surgery's freed-up carpal tunnel. Add the loss of the hand's ability to grab and manipulate things, and one may conclude that the surgery's risks far outweigh its benefits. If you're going to have CTS surgery, definitely see one or two additional doctors for additional opinions. Once, the ligament is cut, it's cut.

[To be fair, the Author admits that there may be a need for new medical studies on the efficacy of said reconstruction surgery.]

But, as surgeons will tell you, at least the pressure is off of the carpal tunnel!

After CTS Surgery, Symptoms Often Return

Is the cure worse than the disease? According to a famous JAMA (Journal of American Medical Association) study, 1/3 of CTS surgeries fail because CTS eventually flares up again. This is especially true for patients who resume repetitive activities that caused the CTS in the first place.

“The surgery, in which the carpal tunnel is decompressed by release of the transverse ligament and degridement, is the most common surgery in the worker’s compensation population. Painful scars were most common in patients receiving such compensation, compared to patients covered by private insurance or other forms of payment, according to a retrospective review of 60 cases at the State University of New York, Buffalo, School of Medicine.

“The initial relief of carpal tunnel surgery may be shadowed by significant scar pain and weakness in almost a third of subjects after 2 years...‘This high incidence of symptom recurrences has not been previously reported,’ says Michael P. Nancollas, MD, a fellow in hand surgery at the western New York school who presented the findings at the American Academy of Orthopaedic Surgeons meeting in Anaheim, Calif.” JAMA, The Journal of the American Medical Association, April 17, 1991, p. 1922(2).

“The study found at an average of 5.5 years’ follow-up that 30% of al patients rate the results as poor to fair. And 57% report return of some preoperative symptoms, most commonly pain, beginning an average of 2 years after surgery, although only one patient required further surgery. Intermittent pain was reported by 42%, digital numbness by 32%, and tingling by by 35%.” Id.

Considering the seriousness (and mixed results) of CTS surgery, one wonders if 1/3 is the basis of a good bet...Also, why bother with so-called minor surgery when it has a poor success rate, symptoms return and one is left in a worse position or condition than one was in prior to surgery?

Also additional factors could further complicate a full and complete recovery.

Example 1: If one has diabetes, the body takes longer to heal than when one didn't have diabetes.

Example 2: If one is middle-aged or elderly, the body takes longer to heal than when one was a child.

Add either or both of those factors to possible post-op complications, standard operation healing time and the aforementioned risks.

Now, does surgery look like an attractive, viable option to you?

Remember that doctors see meds, prosthetics and surgery as the main treatments of choice (not necessarily cure). Here, healing may not necessarily be a synonym for cure. Healing on a molecular level is not viewed as a viable option because it isn't even seriously considered by most doctors.

Doctors believe treating, or alleviating, the symptoms (not causes) = healing, or at least the equivalent of healing. If not, “You just have to learn to live with it.” Is that an acceptable and viable option for you?

This is healing?

Five Year Follow-up

A postmortem review five years later provided less than encouraging results supporting the long-term success of CTS surgery: “...[A]n average of 5.5 years’ follow-up that 30% of all patients rate the results as poor to fair. [Emphasis added].

“And 57% report return of some preoperative symptoms, most commonly pain, beginning an average of 2 years after surgery, although only one patient required further surgery. Intermittent pain was reported by 42%, digital numbness by 32%, and tingling by 35%.

“No correlation between ostoperative results and preoperative symptoms, extent of surgical dissection, physical findings, or electrodiagnostic test results could be identified, Nancollas said.

“The 42% of patients covered by worker's compensation had slower initial improvement, and were off work longer — 8.4 vs 1.7 months for non-compensation patients.” Id.

Add’l Studies

As in the New York study cited above, compensation patients lost more time from work than non-compensation patients in the five year evaluation study. Patients were less likely to return to their original jobs or to resume working at all. [Does this sound like successful surgery to you?]

Dr. Michael P. Nancollas, fellow in hand surgery at the State University of New York, Buffalo, School of Medicine, claims that “Occupational carpal tunnel syndrome is a different disease...Since sear tenderness is the most significant postoperative complaint, attention should focus on retraining or on workplace modifications to prevent recurring pain after surgery, and on techniques such as endoscopic surgery that minimize the size of incisions.” Id.

“Differences between worker's compensation and other patients before and after surgery were also noted in a review of 105 carpal tunnel surgeries in 82 patients at Rose Medical Center and University (of Colorado) Hospital in Denver. The 43 worker compensation patients were younger and predominantly male in contrast to non-compensation patient populations, says Bert F. Jones, MD, who also presented results at the orthopedic academy's meeting.

Dr. Jones says the study was conducted to determine the after effects of CTS surgery, “While compensation has been documented to be a significant outcome variable in other conditions like low back pain, a literature review turned up no references on compensation as a factor in carpal tunnel surgery outcome.” Id.

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