First and foremost, it's so important to find a doctor for carpal tunnel surgery who makes you feel comfortable. That comfort and peace of mind eases the already stressful idea of having hand surgery.

Next, make sure the doctor is an expert in carpal tunnel syndrome. Most doctors do not specialize in the hand, so be sure your doctor is a hand specialist.

Here are key question you can ask the doctor right now, before the day of your operation. Getting comfortable with the doctor and with knowing what will happen is crucial. It will ease the tension in the operating room as doctors and nurses shuffle around you in preparation for the surgery.

• FIND OUT: do you have carpal tunnel? No strings attached self-test.
  

Deciding on hand surgery is a last resort, and a major life event. Your decision says how severe your symptoms really are, and that you need major help right now. 

As much as I would like to, I cannot offer you much comfort sitting here at my desk. But I might be able to offer some practical advice:

Have an open and frank discussion with your doctor, for carpal tunnel or any other surgery. Always ask the questions that are foremost in your mind. 

I can help you formulate those questions here.

First, let me to say that carpal tunnel surgery is a major affair. So you must be your own healthcare advocate. 

That's why the absolute best thing you can do for yourself is always ask questions. A good doctor will be happy to make you feel relaxed. They will spend time with you and provide direct, no-nonsense answers that you clearly understand and are satisfied with.

A bad doctor will not do any of that.

Now, here's how to proceed as you prepare to see a doctor for carpal tunnel surgery.

Print the points below and go over them with your prospective doctor. And be sure to get precise answers that you're satisfied with!

If you’re not satisfied with the answers or if your doctor will not take the time to review them with you then find another doctor! (Honestly, there’s no shortage of good, helpful doctors.)

As you learn more  about carpal tunnel syndrome you come to understand it’s a disease that has no cure. Surgery is just one kind of treatment or "fix” that may last a few months or a few years…or it may not work at all. 

But no surgery on earth comes with a guarantee. So don’t be fooled into believing the outcome is certain.

The NIH says that carpal tunnel syndrome is misdiagnosed almost 50% of the time. Remarkably, that means over 50% of carpal tunnel surgeries are unnecessarily performed. Other problems that look like carpal tunnel include wrist tendonitis, thoracic outlet syndrome,  arthritis, and fibromyalgia.

These disorders can imitate the signs of carpal tunnel but they’re totally unrelated conditions – and usually they don’t require surgery. Your doctor should determine if you have another illness that could be causing your symptoms. So be sure to ask about the certainty of your diagnosis (see the next point for more details).

Electrodiagnosis (EMG) of carpal tunnel syndrome is highly inaccurate. Thus, the doctor’s physical exam must verify the diagnosis. Ask if the physical exam was the basis of your doctor's primary diagnosis.

The physical exam includes specific tests for carpal tunnel (called provocative tests). They include the Tinel, Phalen, and Durkan tests. Ask if these were performed on you - and what the results were. 

Finally, ask your doctor about his or her "opinion of the value of EMG". Be wary if the doctor calls it the “gold standard.” It's not. And that means the doctor is not up to date with the latest scientific data as of January, 2021.

Both the NIH and the American Academy of Orthopedic Surgeons guide doctors’ decisions. They say that a doctor for carpal tunnel syndrome should only recommend surgery when:

• Symptoms have been severe for over 6 months, and
• Patients FIRST tried all non-surgical therapies, without success. These therapies include bracing, exercise, massage, and steroid injections. 

In fact, such non-surgical remedies are highly effective in 97% of patients.

Have a "technical talk" with your doctor: for carpal tunnel surgery, there are 2 types of procedures you may have. The aim of each one is to cut a ligament inside your wrist joint. 

Therefore, the doctor performs either one of the following:

• open carpal tunnel release surgery 
• endoscopic carpal tunnel release surgery

Open release surgery involves making a 2-3 inch long incision on your wrist and palm in order to cut the ligament. In contrast, endoscopic surgery uses an endoscope. Therefore the surgeon makes only one or two tiny incisions in the wrist and palm. (There are also 2 types of endoscopic surgery, called single portal or double portal  surgery.)

Each type of surgery has its advantages and disadvantages. For instance, the open technique causes more hand trauma and longer recovery time.

Most surgeons have greater experience with open release surgery. Fewer surgeons perform endoscopic surgery.

Understand the differences and ask which you will have. A good doctor will have successfully performed thousands of that particular surgery, with great results. Learn more about carpal tunnel surgery preparation here.

All surgical procedures have risks and dangers - like permanent injury and even death. Common carpal tunnel surgery risks include:

• Excessive blood loss
• Nerve injury
• Permanent weakness
• Reaction to anesthesia
• Prolonged healing
• Excessive scar formation

It’s a good idea to ask your doctor questions on the most common problems he or she encounters. The answer may be a red flag.

You will either have a general anesthesia or a local (including nerve block) type of anesthetic. It all depends on the type of surgery you have.

Discuss these options, and whether or not you will meet with an anesthesiologist in advance to discuss all of your allergies. Don’t be afraid to ask your doctor such questions. A good doctor will happily answer them without making you feel like you're questioning their integrity.

You’ve heard of the people who scheduled an appendix removal only to have a leg amputated. This is not urban legend but unfortunately happens every day.

So don’t be shy to double-check your doctor: for carpal tunnel or any other surgery, request that your surgeon pre-operatively confirms and marks the surgical site as you watch. After all, it's your body being operated on.

Remember that carpal tunnel syndrome is a disease with no cure. Symptoms may lessen after the surgery, at least for some time. But in 50% of patients symptoms return within two years. What happens then; another operation that will likely fail? Discuss what might be the next step in case your surgery fails.

You will be in the recovery room immediately after the surgery. Your hand will likely feel numb from the anesthetic and will have bandages. You will receive discharge instructions about wound care and changing the dressing.

Then you will come back in about 10 days to remove the stitches. Prescription and over-the-counter pain medications can manage postoperative pain.

This article goes into detail explaining what to expect after carpal tunnel surgery.

First, get an estimate of how long the recovery period will take. Second, ask what you can and cannot do in this time period. For example: 

What physical limitations are there?

Will you need assistance at home?

How much disability can you expect?

How extensive will the rehab and physical therapy be?

Will you be able to return to work, and when?

What about driving - will you be able to grasp a steering wheel?

Can you have sexual activity?

The NIH and OSHA recognize that carpal tunnel syndrome is largely an occupational disorder. That means yoru job probably caused it. Therefore, symptoms of carpal tunnel syndrome will more likely return if you continue to do the same activities that caused the problem to begin with.

Therefore, you will probably need to reduce or totally stop your job activities (which may require a lot of hand movements). This is something you must discuss with your doctor. For carpal tunnel surgery patients, approximately 90% of them must find a different job after recovery from the operation.

Everybody must restore their hand and finger strength & mobility after hand surgery. Rehab time can take a month or up to a year to complete.

Go over the rehab plan with the doctor right now so you’re not surprised. And be sure to ask about the cost. Rehab is almost always NOT part of the surgery cost. It’s a good idea to ask your doctor if he or she has a financial relationship with the facility you’re referred to for rehab. A good doctor will disclose this without your asking.

After you and your doctor carefully discuss the risks and benefits of hand surgery, ask what the plan is in 1-2 years. If your hand is fine, then you’re golden – and hopefully symptoms won’t return. But what if the pain, numbness or tingling comes back then or soon after? 

Surveys show that over 50% of all surgical patients are not satisfied with their results 2 years later. So plan ahead in the event you don’t see good improvement. What does your doctor see as a next step at that point?

Patients usually are too embarrassed to ask the "hard questions". After all, you assume the doctor for carpal tunnel syndrome is a professional; and asking such questions might sound like you don’t trust their skills.

But don’t assume anything! This is YOUR health on the line. It’s better to find out how good the doctor is now than after your operation. Furthermore, a good doctor will want you to feel comfortable, and will be proud to list his/her achievements.

For example, ask:

• How many (open or endoscopic) surgeries did the doctor perform last year?
  
• What's their 2 year success rate? 
• Has the surgeon ever had problems with a surgery? 
• Did their surgery ever result in damage to the patient? 
• Are there patient complaints against the doctor?

The surgeon will give you instructionsof do’s and don’ts for the weeks and months following the surgery. Aside from the obvious wound care and rehab directions, the doctor normally advises several days of rest until you can work up to routine exercising. 

Also, adjust your posture while seated to avoid straining your arms. Again, you may also have to modify or curtail some job activities. The NIH publishes a good carpal tunnel syndrome fact sheet here.

Your doctor should give you detailed information (several pages of advice) about how to improve your chances of good recovery.

Have a frank and open talk with your doctor: for carpal tunnel surgery or ANY operation, your comfort is paramount. The idea of having hand surgery can be scary. But if you know what will happen and what you can expect, then it’s not such a frightening prospect. 

Be sure to discuss these and any other questions you can think of with your doctor. Remember, don’t fear the “dumb questions” because there are none. Probe hard and get honest answers from your doctor. Finally, listen to your inner voice. If you don’t feel comfortable, then find another doctor. Your hand’s future is at stake!