How can I tell if surgery is needed for carpal tunnel syndrome?

There are several steps you can take. First try a short course of anti-inflammatory drugs. Your doctor can prescribe these. Then visit a physical or occupational therapist.

Therapists can help the nerves and tendons glide freely in the wrist. They can also
stretch the tight band of tissue that crosses the carpal tunnel and puts pressure on the nerve.

You can also have the nerves in your wrist and hand tested. This will show if the nerve is the source of symptoms. It there's a loss of sensation or increased time for the nerve to send a message, surgery may help.

Early treatment is best, especially for older adults. There are some studies that show symptoms may not go away in adult over 70 years. This is because age affects the nerve's ability to regrow or repair itself.

Reference: 

Michael E. Leit, MD, et al. Patient-Reported Outcome after Carpal Tunnel Release for Advanced Disease: A Prospective and Longitudinal Assessment in Patients Older Than Age 70. In Journal of Hand Surgery. May 2004. Vol. 29A. No. 3. Pp. 379-383.

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