Do you find it hard to do daily tasks because of your carpal tunnel syndrome? Do you struggle to get a good night’s sleep? Do your hands still feel numb even after wearing splints and taking pain medication? 

If so, you’re not alone: Carpal tunnel syndrome affects up to six percent of the American population. But many people refuse to live with this type of discomfort — in fact, more than 400 thousand people choose to manage their pain with carpal tunnel release surgery. 

This may come as no surprise. If you’ve had carpal tunnel syndrome for a while, chances are that surgery has crossed your mind once or twice. But how do you know when it’s time to start seriously considering it? 

This article will answer your question, “When is carpal tunnel bad enough for surgery?” by going through the severity of common symptoms, how to decide, and various surgical options. Let’s get started.

How Do You Know If Your Carpal Tunnel Is Severe? 

Carpal tunnel syndrome causes a nerve inside your wrist — called the median nerve — to compress or be crushed entirely due to inflammation or thickening of tendons and nearby tissue. The syndrome is named after the passageway that the median nerve runs through, which is the carpal tunnel. 

Carpal Tunnel Release | Johns Hopkins Medicine
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Determining whether your symptoms are considered severe can be challenging because everybody experiences pain differently, and symptoms vary from one person to the next. 

Severe carpal tunnel syndrome happens when the pain of your symptom begins to interfere with every aspect of your daily life. These severe symptoms include: 

  • Significant loss of hand strength and finger dexterity
  • Reduced sensations to hot or cold temperatures
  • Shooting pain in the arm or tenderness that reaches the shoulders
  • Pain, tingling, or numbness is constant without rest 
  • Difficulty lifting drinking glasses, opening jars, buttoning shirts, turning door knobs, and performing basic grooming tasks

These severe symptoms make it nearly impossible to do regular, everyday tasks.

So, what can you do?

The only permanent relief for these severe symptoms is surgical intervention. 

Understanding When It’s Time to Seek Carpal Tunnel Syndrome Surgery

When carpal tunnel syndrome is severe, many over-the-counter medications and at-home methods won’t relieve your symptoms. Splints, physical therapy, and occupational therapy may seem like they’ll work, but they rarely treat the pressure on the median nerve. 

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If you’ve tried remedies like these without any relief, then it might be time to speak to your specialist or surgeon. Your doctor may recommend carpal tunnel surgery, either open carpal tunnel release or endoscopic carpal tunnel release

But before you can qualify for either of these types of surgeries, your doctor must first determine the severity of the nerve damage. 

Step #1: Conduct a Nerve Conduction Study

If you’ve just started feeling pain in your carpal tunnel (around the inside of your wrist area), your physician won’t recommend surgery immediately. 

Instead, they’ll recommend starting with various treatments and tests to help promote healing and alleviate numbness. One of these tests is called a nerve conduction study.

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A nerve conduction study measures how fast your median nerve responds to electrical impulses.

Two electrodes are taped to your skin, and a small shock is applied to your nerve. If the electrical impulses are slower in the carpal tunnel, your physician can safely rule out other conditions as the source of pain.

Step #2: Visit an Orthopedic Hand Specialist

If the nerve study shows that you may have carpal tunnel syndrome, your physician might refer you to an orthopedic hand specialist.

The hand specialist can administer other treatments, like corticosteroid injections, which can last a few weeks to six months. 

Corticosteroid injections are a common treatment for carpal tunnel syndrome: The steroids help decrease inflammation, relieving some of the pressure on your median nerve.

Step #3: Discuss Surgery Options

In severe cases, you might still be experiencing excruciating pain despite over-the-counter medication, physical or occupational therapy, or corticosteroid injections. 

Your median nerve is so inflamed and damaged that your pain, swelling, and tingling sensations have become unbearable. If this is the case, your orthopedic doctor recommends carpal tunnel surgery. 

What Does Carpal Tunnel Release Surgery Involve? 

Carpal tunnel release surgery involves cutting the carpal ligament or flexor retinaculum to decrease the pressure on the median nerve. 

The surgery opens more space in the carpal tunnel’s narrow passageway so that the nerve’s inflammation and swelling can go down, allowing you to experience less pain and more movement. 

While any surgery has a degree of risk, carpal tunnel surgery has a very high success rate. Academic literature shows that carpal tunnel surgery successfully treats 75% to 90% of symptoms and doesn’t even typically require overnight hospitalization. That means, in most cases, you can go home the same day. 

Deciding Between Carpal Tunnel Syndrome Surgery Options

When deciding what type of surgery you should get, you have two main procedures to choose from: Open surgery or endoscopic surgery. 

Open Carpal Tunnel Release Surgery

Open-release surgery is a standard treatment method where the patient stays awake and receives a local anesthetic at the surgery site. 

The surgeon makes a small three to six-centimeter incision at the base of your palm. Here, the transverse carpal ligament is cut, allowing more room for the median nerve and tendons in the carpal tunnel. 

Carpal tunnel surgical procedure: MedlinePlus Medical Encyclopedia Image
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Once completed, the incision is stitched up for healing. However, while this is a common surgery, its recovery time averages around 30 days. If you use your palm and hands before the incision is fully healed, you can disrupt your body’s healing process and may need follow-up treatment. 

Endoscopic Carpal Tunnel Release Surgery

Endoscopic carpal tunnel release surgery can be done with local or complete anesthesia, meaning you can stay awake or be asleep during the procedure. 

The surgeon will create a tiny incision on your palm and wrist called a portal site. They will then place a thin, flexible tube with a tiny camera inside the wrist incision. 

Image Source: MicroAire Surgical Instruments

The surgeon will perform the surgery by using the camera and small tools at the palm portal site. One of the most popular endoscopic surgeries uses the SmartRelease® procedure, which can be done without large incisions or multiple portal sites. 

Once completed, your incisions will be stitched up, and you’ll have a much quicker recovery time than with open-release surgery1

Benefits of the SmartRelease® Procedure

The SmartRelease® procedure is the leading endoscopic carpal tunnel surgical option available today. It is a minimally invasive procedure that reduces post-operative pain and quickens recovery time by avoiding an open incision from your wrist to your palm1

During the SmartRelease® procedure, the surgeon will make an incision on your wrist about one to two centimeters in length to insert the endoscopic technology. This incision is so small that it doesn’t disrupt the sensitive palm area. 

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This procedure also quickly relieves pent-up pressure in the carpal tunnel. Most patients can return to work and resume normal activities as quickly as 18 days after the surgery. And, because of the smaller incision, SmartRelease® has less scarring than open-release or other traditional endoscopic surgeries1.

At a glance, the main benefits of the SmartRelease® procedure include1

  • It’s a minimally invasive procedure that only has a minimal incision on the wrist
  • It offers a faster recovery than other methods, which means you can return to your daily activities and work quicker
  • It provides near-instantaneous relief to your severe carpal tunnel pain

Most patients who qualify for carpal tunnel surgical treatment can choose between open-release surgery or endoscopic surgery, like SmartRelease®. 

However, in rare cases, some patients have anatomical abnormalities in their wrists that can only be navigated with open-release surgery — so make sure you check with your orthopedic doctor to find out if you’re eligible for the endoscopic option. 


Although carpal tunnel syndrome affects millions of Americans, the symptoms vary greatly. 

Some people only develop mild symptoms with a bit of discomfort, while others’ pain impedes their ability to live everyday life to the point where even lifting, opening, and holding everyday objects becomes near impossible. 

The good news is that carpal tunnel syndrome can be treated with splints, therapy, and corticosteroid injections. However, surgery may be the next step to combating your pain if these don’t work. 

Most patients can choose between open-release and endoscopic surgery like SmartRelease®. While open surgery provides relief, the incision takes longer to heal, whereas the SmartRelease® procedure is less invasive and allows patients to return to normal activities much more quickly1.

If you’re considering carpal tunnel surgery and weighing your options, check out our patient stories and learn more about how SmartRelease® can treat carpal tunnel pain — and how you can get your life back.