Surgery may be indicated if the:

the patient's symptoms have not responded to nonoperative treatment.

the symptoms are very severe, or nerve testing indicates significant damage to the median nerve.

the patient has had symptoms for a number of years before seeking medical advice. It may be better to proceed directly to surgery in these types of cases.

The operation is a short procedure usually done in an outpatient setting. The 30-minute procedure can be performed with a local or regional anesthetic allowing the patient to remain awake during the operation.

The two most popular procedures are the open technique and the endoscopic technique.

	Open Technique- Also called an "open release". In this procedure a small incision is made at the base of the palm. This allows the surgeon to see and cut the transverse carpal ligament to open the roof of the tunnel. By releasing the ligament, pressure on the median nerve is eliminated.
	Endoscopic Technique - This procedure uses a small tube that the doctor inserts through a ½" incision in the patient's palm or wrist. A fiberoptic camera in the tube allows the surgeon to see the underside of the transverse carpal ligament, which can then be released with a special knife.

Both of these techniques have relatively high success rates; approximately 90% of patients get relief from their symptoms. There are advantages and risks associated with each method. The preferred procedure depends on the surgeon's experience and should only be selected after the options have been discussed in detail.

What types of complications may occur?

There are possible complications from surgical treatment, but they are relatively rare. There are risks associated with anesthesia, infection, and possible injury to nerves, vessels, or tendons. Other potential problems following surgery include finger stiffness, a tender scar, persistent numbness, and (rarely) increased pain.