Signs You Might Need Carpal Tunnel Release Surgery

Carpal tunnel syndrome (CTS) often starts quietly—a slight tingling in your fingers, or an occasional numbness when you wake up. For many, the symptoms are manageable with rest, splints, or steroid injections. But when these strategies no longer work to relieve pain, and the discomfort and chronic pain becomes a daily obstacle, it may be time to consider carpal tunnel release surgery. According to documentation from the Institute for Quality and Efficiency in Health Care [IQWiG], 2024), surgery becomes a viable option when symptoms return frequently despite conservative treatment, and when abnormal sensations become progressively disruptive.

At Ortho Westmount, a leading orthopedic clinic in Montreal, our orthopedic surgeons can assess and help treat your carpal tunnel syndrome. If you, or a loved one, have been suffering from severe carpal tunnel syndrome, here is what you need to know if surgery is the right option. 

How Do You Know If Carpal Tunnel Surgery Is Needed?

It can be difficult to know when discomfort crosses the line from temporary to permanent. One clear sign is persistent symptoms of carpal tunnel syndrome despite trying nonsurgical approaches. When wrist splints, physical therapy, activity changes, and nonsteroidal anti-inflammatory drugs no longer ease the sensations, and the discomfort begins affecting sleep, work, or personal routines, this may signal that the median nerve is under consistent pressure.

Some patients describe constantly needing to "shake out" their hands. Others find that tasks like gripping a steering wheel or holding a phone become increasingly difficult. If you're beginning to feel pain that lingers even during rest, or you’ve developed noticeable hand weakness, these are signs that more proactive intervention may be needed.

How Do You Know If Your Carpal Tunnel Is Severe?

Severity isn't always obvious to the untrained eye. While early symptoms come and go, advanced carpal tunnel syndrome tends to remain constant. Numbness may no longer subside with rest, and the sensation of “pins and needles” can evolve into total loss of feeling in the fingers. When this happens, the muscles at the base of the thumb may begin to shrink—an indication that nerve signals are no longer reaching the muscle.

Tests such as electromyography (EMG) and nerve conduction studies can confirm whether the nerve root is significantly compressed. This diagnostic clarity helps determine whether surgery is not just beneficial, but necessary to prevent permanent damage.

When Is It Too Late to Fix a Carpal Tunnel?

Although many patients worry about waiting too long, it’s rarely “too late” to treat CTS. That said, outcomes are far better when surgery is performed before muscle wasting or irreversible nerve injury occurs. Much like lumbar decompression surgery for spinal stenosis or a herniated disc, the window for optimal recovery narrows as pressure on the nerves persists over time.

If you've been dealing with chronic symptoms for years, there may still be a path to relief—but the likelihood of a full return to strength and sensation may be reduced. Early consultation with a specialist can help you understand your unique prognosis and timing.

Who Is a Good Candidate for Carpal Tunnel Surgery?

Candidates for carpal tunnel release surgery typically include those who have exhausted non surgical treatments, such as steroid injections or wrist splinting, and still experience functional limitations. If you're healthy enough for outpatient procedures and have a confirmed diagnosis via nerve studies, you're likely a good surgical candidate.

Unlike some forms of spine surgery, carpal tunnel release is minimally invasive. This means a shorter recovery and fewer risks. Most patients regain hand strength gradually, and symptoms like tingling and night pain often resolve within days or weeks.

What to Expect from Carpal Tunnel Release Surgery

Surgical procedures used to treat carpal tunnel syndrome involve dividing the transverse carpal ligament to relieve pressure on the median nerve. By creating more space within the carpal tunnel, the procedure helps restore normal nerve function and reduce or eliminate symptoms such as numbness, tingling, and pain. There are two main carpal tunnel syndrome surgery techniques used to achieve this: open surgery and endoscopic surgery.

In an open carpal tunnel release, the surgeon makes a small incision—typically 2 to 5 centimeters—at the base of the palm. This allows direct visualization of the ligament and surrounding structures. Open surgery provides a clear view of the anatomy, which may be beneficial in more complex or advanced cases. However, because the incision is larger, patients may experience more tenderness in the palm during early recovery.

By contrast, endoscopic carpal tunnel release uses one or two much smaller incisions, often less than 1 centimeter in size. Through these incisions, the surgeon inserts a tiny camera and specialized instruments to cut the ligament from underneath the skin. This minimally invasive approach typically results in less post-operative pain, faster return to daily activities, and a smaller scar. However, because the surgeon has a limited view compared to the open method, endoscopic surgery may not be suitable for all patients, particularly those with prior wrist surgeries or atypical anatomy.

What Is the Cost of Surgery?

The cost of carpal tunnel surgery can vary based on several factors, including whether you're accessing care through the public system or opting for private treatment. We provide full transparency on service fees and financing options during your consultation, so there are no surprises.

Is It Time to Get Started?

If your symptoms are becoming more frequent, more intense, or more disruptive, it may be time to speak with a specialist. Carpal tunnel syndrome rarely improves on its own once it's reached a moderate or severe stage. An early assessment could mean the difference between temporary discomfort and permanent damage. Our team brings the same level of precision and care to all procedures, from wrist surgery to advanced sports medicine and spine interventions.

Contact us to get started on your journey to lasting pain relief and restored hand function.

References:

• Institute for Quality and Efficiency in Health Care (IQWiG). (2024, December 17). Carpal tunnel syndrome: Learn More — When is surgery …. In InformedHealth.org [NCBI Bookshelf]. Retrieved June 10, 2025, from https://www.ncbi.nlm.nih.gov/books/NBK279597/
• Azad, A. (2025, June 30). Do I need surgery for my carpal tunnel syndrome? Keck Medicine of USC. Retrieved June 10, 2025, from ttps://www.keckmedicine.org/blog/do-i-need-surgery-for-my-carpal-tunnel-syndrome/
• HealthLink BC. (n.d.). Carpal tunnel syndrome: Should I have surgery? Government of British Columbia. Retrieved June 10, 2025, from https://www.healthlinkbc.ca/healthwise/carpal-tunnel-syndrome-should-i-have-surgery
• Orthopedic Institute of New Jersey. (n.d.). Carpal tunnel surgery. Retrieved June 10, 2025, from https://orthopedicnj.com/news/carpal-tunnel-surgery