I've heard that carpal tunnel syndrome requires immediate surgery to save the nerve. But my doctor insists on a six to eight week course of physical therapy with splinting and exercise for me. Does this seem right?

You may be confusing acute versus chronic carpal tunnel syndrome (CTS). Both conditions cause compression of the median nerve in the wrist and hand. Wrist pain, numbness, and tingling are common symptoms in either condition.

Most people develop chronic CTS. This is a gradual onset of symptoms brought on by compression of the nerve for a variety of reasons. Repetitive use of the wrist and hand are often blamed for this condition. Conservative care with activity modification, splinting, and tendon and nerve gliding exercises are standard treatment modalities for chronic CTS.

Acute CTS may require immediate medical response and surgical care. Acute means the condition comes on suddenly -- in a matter of minutes to hours rather than weeks to months. The cause is most likely trauma leading to bone fracture, joint dislocation, or bleeding into the carpal tunnel compartment.

In the case of acute trauma, something must be done in order to restore blood flow and preserve nerve function. That something is usually surgery. The procedure is a surgical decompression. The surgeon makes an open incision in the wrist and removes any fluid or tissue compressing the nerve.

When acute CTS occurs, early diagnosis and treatment ensure a successful outcome. The patient's history and exam are usually enough to verify an acute cause of the syndrome. The speed with which the symptoms develop and progress is a tip-off as well. Early release of pressure on the nerve can help return complete function of the nerve.

Unless you've had a sudden traumatic event causing your CTS, the course of nonoperative care outlined by your doctor is standard procedure.