====== Carpal Tunnel Syndrome Surgery Indications ======

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[[Open carpal tunnel release]] is indicated in patients with [[carpal tunnel syndrome]] who meet one or more of the following criteria:

Failure of [[conservative treatment]]

– Persistent symptoms (pain, numbness, paresthesia) despite ≥6–12 weeks of non-surgical management (splinting, NSAIDs, steroid injections).

Severe clinical signs

– Thenar muscle atrophy

– Weakness in thumb abduction or opposition

– Persistent or worsening sensory loss

Electrodiagnostic confirmation of severe median neuropathy

– Markedly slowed nerve conduction across the carpal tunnel

– Evidence of axonal loss (reduced CMAPs/SNAPs)

Acute carpal tunnel syndrome (e.g., post-traumatic, hematoma, infection)

– Requires urgent decompression, usually via an open approach

Recurrent or persistent CTS after endoscopic release

– Open revision provides better visualization of residual compression

Surgeon or anatomical preference

– Open approach may be favored in cases with:

– Anomalous anatomy

– Space-occupying lesions (e.g., lipoma, ganglion)

– Prior wrist surgery or scar tissue