Angelica Bottaro is a writer with expertise in many facets of health including chronic disease, Lyme disease, nutrition as medicine, and supplementation. 

Jenny A. Dhingra, MD is a board certified anesthesiologist practicing with Atrium Health in Charlotte, North Carolina.

Carpal tunnel syndrome occurs when nerves in the carpal tunnel (a passageway between the palm and wrist) become compressed. People with carpal tunnel syndrome experience pain that makes it difficult to use their hands. There are various treatment options available for carpal tunnel syndrome, including carpal tunnel injections and carpal tunnel surgery.

This article discusses the two treatments and the benefits and side effects. 

Carpal tunnel injections are considered a non-surgical treatment option for carpal tunnel syndrome. They involve the injection of corticosteroids into the affected area.

Corticosteroids are medications designed to reduce both swelling and inflammation. When the medication reaches the carpal tunnel, it relieves symptoms. The injections are highly effective; in some cases, long-term relief is achievable through carpal tunnel injections.

However, that is not always the case, and symptoms can return for people with the syndrome even after getting injections.

It is hard to determine how long a person will experience symptom relief from a carpal tunnel injection because each person is different. For people with mild cases of carpal tunnel, relief can last for a year or longer.

The needle is placed into the wrist crease where the hand meets the arm to perform the injection. The medication is then injected into the carpal tunnel.

The corticosteroid used is often mixed with lidocaine, which is an anesthetic. The anesthetic is used to help reduce pain from the injection itself. When mixed with corticosteroids, lidocaine can dilute the medication, which helps it reach more areas within the carpal tunnel.

Getting a carpal tunnel injection can cause some mild pain. If you experience severe pain during the injection, be sure to alert your healthcare provider, as severe pain may mean they are not inserting the needle correctly. 

Carpal tunnel injections are considered safe and effective. Possible side effects can include:

If you want to get a carpal tunnel injection, you will have to see an orthopedist that specializes in injuries and conditions of the hand. They will perform the injection at their office.

The total cost for one injection will vary depending on where you live, the specialist you have chosen, and whether or not you have insurance. People with Medicare can expect to pay between $84 and $146 per shot.

Without insurance, carpal tunnel injections can be up to $1219 per injection, and more depending on the severity of carpal tunnel syndrome. If you are not sure what’s covered for you, speak to your insurance provider to discuss the cost of carpal tunnel injections in your area.

Carpal tunnel release surgery is a more intense treatment option for people with carpal tunnel syndrome, often used when carpal tunnel syndrome doesn't work or symptoms return after cortisol injections.

During carpal tunnel release surgery, an incision is made into the wrist at the base of the palm. This cut exposes the transverse carpal ligament. The ligament is then cut to release pressure on the median nerve and relieve symptoms.

While surgery can be effective at relieving the symptoms of carpal tunnel syndrome for a long period of time, some people may opt to get more injections if their symptoms return.

There are two types of carpal tunnel release surgery. The first is open release when the wrist is cut open to perform the surgery. The second, endoscopic carpal tunnel release, is done less invasively.

Endoscopic carpal tunnel release is done using an endoscope, a flexible, thin tube with a camera on end. This type of surgery uses two cuts. The fist cut allows the endoscope into the wrist to guide the surgeon. The second cut is above the carpal tunnel so the surgeon can access the transverse carpal ligament. The ligament is cut like in open release, and pressure on the median nerve is released.

The two types of surgery are both effective, although recent research has found that endoscopic carpal tunnel surgery results may be slightly better in comparison.

Carpal tunnel release surgery is considered a day surgery, so you won’t be required to spend the night in the hospital.

Following carpal tunnel surgery, you will be required to wear a splint and participate in a physical therapy program as a way to restore proper movement in the wrist and hand. Recovering from carpal tunnel surgery may take anywhere from a few days to a few months.

There are some side effects to be aware of, including:

All surgeries come with some risks and carpal tunnel release is no different. The risks associated with this specific surgery include:

Carpal tunnel release surgery is done at an ambulatory center or a hospital by a qualified orthopedic surgeon. The cost varies depending on factors including whether or not you have insurance, where you choose to get the surgery, and how much aftercare will be required.

Surgery at an ambulatory center will cost less than if you were to get it done at the hospital. It is estimated that carpal tunnel release surgery for someone without insurance can cost between $2149 to $9927. The procedure is typically covered if a person has insurance but a copay may be involved. In that case, the copay could be as much as $1000.

While most insurance providers cover carpal tunnel surgery in severe cases, you will have to contact your insurance provider to be sure if yours is covered. They will be able to break down costs associated with the surgery in your specific case. 

When comparing the two treatment options, you have to consider several factors. For example, if you have a mild case of carpal tunnel syndrome, jumping directly to surgery may not be the best option. You could benefit from getting the injections first to see how they work for you.

However, if you have already gone through other forms of treatment and nothing seems to work, surgery is your best option.

How long you want relief is also a factor. Injections are capable of providing long-term relief for a year or more. However, that isn’t the case for everyone. Surgery, on the other hand, has shown to be a permanent fix for as many as 95% of people with carpal tunnel syndrome.

When you meet with your healthcare provider, they will give you the options that would be most effective in treating your specific case of carpal tunnel syndrome.

Surgery and injections are not typically used together. Injections are reserved for first-line therapy in mild to moderate cases because they can be effective and are less invasive. Surgery is usually performed if a person’s symptoms return following injection therapy.

In some cases, a person can continue to get injections after surgery if their surgery didn’t relieve all the symptoms or the symptoms reappear.

Regular carpal tunnel injections following surgery could increase the risk of nerve and tendon damage. It’s important to speak to your medical provider about your concerns, expectations, and the risks associated with doing both treatments.  

Both carpal tunnel injections and carpal tunnel release surgery come with side effects. It can be hard to deal with the side effects, but there are ways to handle the healing process.

The most common side effect is pain and swelling. To avoid making the pain worse, return to your normal activities slowly. You should also avoid using the affected hand as much as possible. While this may be difficult, it will help speed up recovery time.

You can also take over-the-counter pain medications to help ease the pain. However, if you are prescribed something specifically for pain, use that instead. Mixing pain relievers should be completely avoided unless your medical provider tells you otherwise.

Applying ice to the area while the hand is elevated above the heart every two hours for roughly 10 to 20 minutes can also help reduce pain and swelling.

If you experience any signs of infection such as a fever, chills, increased pain when it should be improving, bleeding, or discharge from the area, contact your medical provider immediately or go to the hospital. Infections require prompt treatment.

Carpal tunnel injections and carpal tunnel release surgery are two effective treatment options if you develop carpal tunnel syndrome. Injections are less invasive but are required more often. Surgery is typically associated with a complete reduction in symptoms for many people but comes with a longer recovery process.

Both procedures come with side effects, mainly, pain and swelling in the area. These side effects can be managed with pain medications, the elevation of the affected hand, and ice. To determine which procedure would be best for you, you should speak directly to your medical care provider.

Dealing with carpal tunnel can be excruciating. To make matters worse, it can also be difficult to navigate the treatment landscape. When you are investigating possible treatment options, it’s important to look at the pros and cons of each.

While both options provide relief, your personal case will ultimately determine which one is best for you. If you are unsure where to start, contact your medical care provider for more details on both treatment options and how they can help you.

The best procedure for carpal tunnel syndrome depends on a person’s case and personal preferences. While surgery can provide the most relief, it is more invasive and requires more recovery time than carpal tunnel injections. The best procedure is the one that works best for you.

Both endoscopic carpal tunnel release surgery and open release surgery are effective. However, endoscopic is less invasive and requires minimal incisions. According to research, the outcomes are the same or slightly better in people that receive endoscopic carpal tunnel release surgery versus open release surgery.

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