I think I need carpal tunnel surgery for the numbness in my fingers and pain in the wrist. I'm wondering if it's better to go with a new, younger doctor who is just out of school or someone from the old school who's been around awhile but maybe hasn't had the most recent training. What do you suggest?
There is nothing that says you can't go to both for an evaluation and their recommendations and then decide. If you get two completely separate suggestions, you can see a third surgeon for some additional input. Although carpal tunnel surgery is fairly simple as surgical procedures go, it is still your wrist and hand and it is still surgery. No one will fault you for being cautious in your decision-making. We can tell you some of the changes that have occurred over the past 25 years in the management of carpal tunnel syndrome. That might help you evaluate any advice or recommendations you receive. This information comes from a study done by sending an email survey to the members of the American Society for the Surgery of the Hand (ASSH). One of the major changes in the way CTS is managed today is the increased use of conservative (nonoperative) care over a longer period of time. Surgery is still a treatment choice, but it takes a back seat to activity modification, antiinflammatory medications, hand therapy with a physical or occupational therapist, splinting, and possibly steroid injections. If after a lengthy period of time (at least three months), there has been no (or minimal) change in symptoms, then surgery to release pressure on the median nerve may be advised. Surgery today is more likely to be done without an open incision using an endoscope. Choice of anesthesia has shifted from regional blocks to local anesthesia with sedation. Today's surgeon is less likely to use sutures deep within the carpal tunnel and less likely to inject corticosteroids into the tunnel during surgery. Only about one-third of the surgeons prescribe antibiotics before surgery to prevent infection. In keeping with current evidence and recommended clinical practice guidelines, 85 per cent of the group that responded order electrodiagnostic tests before doing surgery. This test confirms that the median nerve is compromised and that the problem is indeed coming from pressure (or compression) on the nerve in the carpal tunnel. This is important because carpal tunnel symptoms can develop with pressure on the nerve anywhere from the neck down to the wrist. Releasing soft tissue structures in the wrist will not alleviate the symptoms if the problem is really coming from above (e.g., the neck or elbow). After surgery, fewer surgeons apply a splint to the patient's arm. In fact, half as many practice this approach compared with 25 years ago. The surgeons surveyed this time indicated that their expected outcomes are for patients to experience pain relief fully with gradual return of normal sensation, movement, and strength. One of the biggest changes observed from 25 years ago to the present time is a narrower gap in treatment practices and opinions on the management of this problem. In other words, surgeons today are practicing more consistently in the same manner than in previous years. Hopefully, you won't find much difference between surgeons consulted, thus making your decision easier.