Carpal tunnel syndrome can return whether you had non-surgical or surgical therapy. Recurrence of symptoms is not the rule, but it occurs with enough frequency that it’s a problem for many people. In fact, over 25% of patients report recurrent symptoms within one year of a non-surgical intervention. About 56% of patients report recurrent symptoms due to a failed surgery within 2 years. Usually, when symptoms come back, it’s due to one of the three reasons listed below.

When symptoms return shortly after treatment (non-surgical or surgical) it usually means the condition was never fully resolved to begin with. Days or weeks later, symptoms seem like they came back – but in reality they never fully disappeared.

Certain harmful hand activities like constant gripping, pinching, grip-and-release, acute wrist bending, rapid finger movements, and vibration can result in carpal tunnel syndrome. If you eliminate symptoms with therapy, and then engage in the same harmful activity as before, the problem will start all over again. It’s important to realize that the way you used your hands previously was the likely reason you got carpal tunnel syndrome to begin with.

The warning signs that carpal tunnel syndrome is coming back are identical to when symptoms first began. They include one or more of the following symptoms.

• Pain
• Numbness
• Burning
• Tingling
• Shooting electric shocks
• Weakness
• Clumsiness
• Itching

These symptoms may occur during the day or while trying to sleep. They may flare up when performing a particular hand task like turning a door knob, typing a lot or squeezing a handle.

Recurrent carpal tunnel syndrome can be addressed with non-surgical (“conservative”) or surgical treatments. Non-surgical treatment usually is applied to mild or moderate cases of carpal tunnel syndrome. They consist of one or more of the remedies listed below. Remember, the more severe your symptoms the more of these treatments may be required (and used in combination). This Quiz tells you your carpal tunnel severity stage.

Mild and moderate carpal tunnel syndrome is by far easier to treat than the severe stage of the condition. Usually, one or more of the following remedies is successful:

• Use NSAID pain relievers.
• Rest you hand frequently.
• Avoid the activities that stressed you hand (e.g., gardening, piano, shoveling).
• Modify the activities that stressed your hand (e.g., wear protective gloves, use ergonomic devices).
• Start night bracing with a certified carpal tunnel brace (not a regular pharmacy brace) for 4-6 weeks.
• Do stretching exercises designed for carpal tunnel.
  

For severe cases of carpal tunnel syndrome, you will likely need most of the above remedies PLUS one or more of the remedies listed below.

• Steroid injection: A steroid injection can reduce inflammation around the median nerve. The immediate success rate is about 45%. But after a few months, nearly all patients who had initial success feel symptoms come back. They may require another steroid shot. But due to the steroid’s potential side effects, you are restricted in the number of injections you can have per year.

• Oral steroids: Your doctor may prescribe oral steroids. This 10-14 day course can help with symptoms. However, it usually is much less effective than a steroid injection into the wrist joint.

• Hydrodissection: Hydrodissection therapy is relatively new, and few doctors perform it. It is used to separate the median nerve from surrounding restrictive, adhesive tissues. After about 3-6 months you may see symptoms return, whereupon you will need another hydrodissection. There is no limit to the number of hydrodissection procedures you can have.

• Myofascial release massage: This is a highly effective remedy for relieving carpal tunnel symptoms. The technique loosens restrictive adhesions around the median nerve. This results in reduced swelling, and less compression on the median nerve. Your partner can learn to perform myofascial release massage around your wrist area and lower forearm. It requires twice daily application for at least 30 days. The CarpalRx device performs the same massage automatically.

• Surgery: Surgical intervention is considered the last resort to treat carpal tunnel syndrome. Called “carpal tunnel release surgery”, there are two basic types: open and endoscopic. The open technique is more traumatic, has more post-surgical pain, and requires more careful aftercare and longer healing time. But it’s considered the “safer” method because it’s less likely the surgeon will make a mistake. The endoscopic technique has milder post-surgical pain, easier aftercare, and a quicker healing time. But it’s considered less safe because the surgeon cannot directly see the structures being cut, increasing the chances of a mistake.
  

Symptoms of carpal tunnel syndrome can indeed return after surgery. Usually symptoms return in over 56% of patients within two years. Generally, the more severe the symptoms going into the surgery, the greater the likelihood of having recurrent symptoms afterward.

• Surgical pain versus carpal tunnel pain: It’s important to distinguish the pain from the surgery from the pain due to carpal tunnel syndrome. Post-surgical pain may linger for several weeks or months. If after that you still have pain, it usually means the surgery was unsuccessful (called a "failed surgery").

• Revision surgery: After a failed surgery, fewer than 3% of patients opt for another, identical surgery. This is called a revision surgery. But the popularity of revision surgeries is declining because patients believe if the first one didn’t work, why go through the pain and inconvenience of another. Indeed, the published success rate of revision surgery is less than 20%. 
  

Every successful carpal tunnel therapy aims to reduce pressure on your median nerve. That means you must reduce any excess stress and strain on your wrist joint The best ways to do so include the following:

• Take frequent rest breaks for your hand.

• Don't twist and bend your wrist.

• Don't repeat the same hand and finger motions for long periods of time (e.g., typing, stirring, sorting). 

• If you know you will be stressing your hand for a short time (such as lifting a heavy load or excessive wrist bending) wear a wrist brace. It will prevent over-bending of your wrist.

• Assess the activity that’s stressing you hand. Either find ways to do the same thing with less stress (modify the motion or activity) or else eliminate it altogether.

• Use a relaxed grip or ergonomic tools to reduce grip pressure.

• Avoid using vibrating equipment or wear gloves when appropriate.

• Use your affected hand for lighter, less stressful activities.

• Wear gloves in cold climates.

• Switch out older devices for newer ergonomic products.

• Maintain good posture at your workstation.

• Do quick finger and hand stretching exercises every couple hours, and especially right after any hand stressing activity.

• If you are at high risk, pay special attention to return of symptoms so you can attack the problem early. High risk conditions are: 

• Pregnancy
• Diabetes
• Rheumatoid arthritis
• Hypothyroidism
• Obesity
• Excessive alcohol consumption
  

After using a non-surgical or surgical treatment, carpal tunnel syndrome usually goes away. But after using either therapy it can come back again in some patients. Essentially, you would treat such recurrent symptoms the same way you would treat the original symptoms. Mild and moderate cases of carpal tunnel can be successfully treated with various non-surgical remedies. For more severe cases, steroid injections, hydrodissection or myofascial release massage can be effective. When these fail, surgery is usually recommended. If you have a history of carpal tunnel syndrome and are experiencing symptoms after treatment, you should consult with your doctor for follow-up advice.