Carpal Tunnel Surgery

What Is Carpal Tunnel Surgery?

Carpal tunnel surgery, also called carpal tunnel release, is an operation that relieves pressure on the median nerve where it passes through the wrist. The surgeon divides the transverse carpal ligament — the tight band of tissue that forms the roof of the carpal tunnel — so the nerve has more room. It is offered to people whose numbness, tingling, night pain or hand weakness persists despite non-surgical care, or whose testing shows the nerve is under significant pressure.

Carpal tunnel syndrome usually starts quietly. A tingling sensation in the thumb or fingers. Numbness that wakes you at night. A habit of shaking the hand to “wake it up”. Discomfort that travels from the wrist into the forearm. Over time these symptoms can become more than an inconvenience: you may start dropping objects, struggling with buttons, losing grip strength, or finding that computer work, driving, cooking, writing and sleep are repeatedly interrupted.

For most people the first question is whether surgery is truly necessary. That caution is sensible. The hand is central to independence, work, communication and daily comfort, and nobody wants an operation they could reasonably have avoided. This page explains what the procedure involves, who genuinely needs it, what the alternatives are, how long the operation and the recovery take, and what a realistic result looks like — including the honest limits of what surgery can achieve once a nerve has been compressed for a long time.

One brief note on spelling, because it causes real confusion online: you will sometimes see the condition written as carpel tunnel, and occasionally even typed as cuppa tunnel. Both are misspellings of the same condition — carpal tunnel syndrome, named after the carpal bones of the wrist.

The Carpal Tunnel and the Median Nerve

The carpal tunnel is a narrow passageway on the palm side of the wrist. Its floor and walls are formed by the small carpal bones, arranged in an arch; its roof is the transverse carpal ligament, a strong, inelastic band of tissue. Nine flexor tendons and the median nerve share this confined space, and there is very little spare room inside it.

The median nerve provides sensation to the thumb, index finger, middle finger and part of the ring finger. It also powers some of the muscles at the base of the thumb — the muscles you rely on for pinch and fine control. When swelling, thickened tissue, repetitive strain, inflammation, fluid retention or a naturally narrow tunnel reduces the space inside, the nerve is the structure that suffers first. Sustained compression interferes with the nerve’s blood supply and its ability to transmit signals, and that produces the numbness, tingling and weakness that define the syndrome.

This anatomy explains both the problem and the operation. Because the ligament is the only soft boundary of the tunnel, dividing it is the one reliable mechanical way to enlarge the space. Nothing is removed during a release. The nerve and the tendons stay exactly where they are; the roof simply stops pressing down on them, and over the following weeks the ligament heals in a lengthened position, leaving a permanently larger tunnel.

What are the signs of carpal tunnel in your hand?

The classic carpal tunnel symptoms are numbness and tingling in the thumb, index finger, middle finger and the thumb side of the ring finger — typically sparing the little finger. Beyond that pattern, the signs that most often bring people to a specialist include:

• Numbness or tingling that wakes you at night, often eased temporarily by shaking or dangling the hand
• Pain or burning in the wrist or palm that can travel up into the forearm
• Symptoms triggered by holding a phone, steering wheel, book or computer mouse in a fixed position
• Reduced grip strength and a growing tendency to drop things
• Clumsiness with fine tasks such as buttons, coins, jewellery clasps or handwriting
• In advanced cases, constant numbness or visible flattening of the muscle pad at the base of the thumb

The little-finger detail matters more than it may seem. The little finger receives its sensation from the ulnar nerve, not the median nerve, so numbness centred there points away from the carpal tunnel and towards a different site of compression — most often the ulnar nerve at the elbow, which is treated with cubital tunnel surgery rather than a carpal tunnel release. Getting this distinction right before any operation is one of the main jobs of the diagnostic work-up.

What triggers carpal tunnel flare-ups?

Flare-ups are usually triggered by anything that raises the pressure inside the tunnel or increases swelling around the tendons that run through it. Common triggers include sustained wrist flexion or extension — sleeping with the wrist curled under the pillow, long typing or mouse sessions without breaks, prolonged gripping of tools, handlebars or a steering wheel — as well as vibrating equipment and repetitive forceful hand work. Fluid retention can also provoke symptoms, which is why flare-ups are frequent in pregnancy and why some people notice a link with hormonal changes or weight gain. Underlying conditions such as thyroid disease, diabetes or inflammatory arthritis can make the nerve more vulnerable when they are not well controlled. Identifying your own trigger pattern is useful in itself: it guides splinting, workplace changes and the timing of treatment.

Can carpal tunnel go away on its own?

Sometimes, yes — but not reliably, and not in every case. Symptoms that appear during pregnancy often settle after delivery once fluid retention resolves, and mild tingling linked to a temporary period of unusually heavy hand use may fade when the activity stops. Established carpal tunnel syndrome behaves differently. Once nerve testing shows clear compression, or once numbness becomes constant and grip weakens, spontaneous recovery is uncommon and the risk of permanent nerve change rises with time. The practical rule is straightforward: intermittent, mild, recent symptoms are reasonable to treat conservatively and observe; persistent or progressive symptoms deserve a proper assessment rather than more waiting.

Carpal Tunnel Treatment Before Surgery

Carpal tunnel treatment does not usually begin with an operation. In early or mild cases, many people improve with conservative measures, and a responsible specialist will explain these options before discussing surgery at all. The mainstays are:

• Wrist splinting, especially at night. A splint holds the wrist in a neutral position, which keeps tunnel pressure at its lowest and often reduces night waking within a few weeks of consistent use.
• Activity modification and ergonomics — adjusting keyboard and mouse position, taking regular breaks from gripping or repetitive work, and avoiding prolonged extreme wrist positions.
• Treatment of underlying conditions such as thyroid disease, diabetes or inflammatory arthritis, managed by the relevant treating physician, since better control of these conditions can reduce nerve irritation.
• Hand therapy, including tendon and nerve gliding exercises and guidance on protective hand use.
• Corticosteroid injection into the carpal tunnel, which can reduce swelling around the tendons. Relief is often real but frequently temporary, and the response to an injection can also carry diagnostic value.

These measures work best when symptoms are intermittent, sensation is preserved between episodes, and the thumb muscles remain strong. They are less likely to hold when compression is severe, because none of them changes the size of the tunnel permanently.

How can I fix my carpal tunnel?

It depends on how far the compression has progressed. Carpal tunnel syndrome treatments fall into two broad groups: measures that lower the pressure temporarily — splints, activity changes, therapy and injections — and surgery, which enlarges the tunnel permanently by releasing the ligament. For mild, early disease, the first group is often enough, at least for a long period. For persistent, recurrent or progressive disease, release surgery is the only treatment that addresses the mechanical cause directly. What does not fix carpal tunnel syndrome is ignoring it: adapting by using the other hand, accepting broken sleep, or waiting for obvious weakness tends to trade a smaller problem now for a harder one later.

Who May Need Carpal Tunnel Surgery

Not everyone with carpal tunnel syndrome needs an operation, and a careful assessment protects you from surgery you do not need just as much as it identifies surgery you do. Broadly, surgery enters the discussion when symptoms persist despite a fair trial of conservative care, when they return after temporary improvement, or when there are signs that nerve function is deteriorating.

Patterns that commonly lead to a surgical discussion include persistent numbness or tingling despite splinting or therapy, frequent night waking, progressive weakness, declining hand function at work or at home, and abnormal nerve test results. Surgery may be raised earlier — sometimes as the first-line option — when there are markers of significant compression: constant numbness rather than intermittent tingling, measurable weakness of the thumb muscles, or visible wasting at the base of the thumb. These findings suggest the nerve is already struggling, and time matters more at that stage.

Diagnosis begins with a careful history and physical examination. A hand surgeon, orthopaedic specialist, neurosurgeon or other relevant physician assesses the distribution of your symptoms, hand strength, sensation, range of motion and the provocative signs that suggest median nerve compression at the wrist. Just as importantly, the examiner checks for conditions that can mimic carpal tunnel syndrome: nerve compression in the cervical spine, peripheral neuropathy affecting both hands and feet, arthritis, tendon disorders, or nerve entrapment at another site along the arm.

Nerve conduction studies and electromyography measure how well the median nerve transmits signals and whether the muscles it supplies are affected. These tests are particularly valuable when symptoms are atypical, when surgery is being considered, or when there may be more than one cause of numbness — a common situation in people with diabetes. They also grade severity, which shapes both the urgency of treatment and the expectations for recovery.

Ultrasound is used in selected cases to look at the median nerve itself and the structures around it — tendon swelling, cysts or anatomical variations. X-rays are not needed to diagnose carpal tunnel syndrome, but they may be taken when arthritis, an old fracture or another wrist problem is suspected alongside it.

Conditions and Indications Treated by Carpal Tunnel Release

Carpal tunnel release is designed to treat one specific problem: compression of the median nerve at the wrist. The reason for that compression varies, and understanding it helps the medical team plan care and address contributing factors rather than treating the wrist in isolation.

The most common indication is idiopathic carpal tunnel syndrome — no single identifiable cause, but a nerve compressed within a naturally narrow or inflamed tunnel. Anatomy, repetitive wrist positions, tendon swelling, age-related tissue changes and occupational patterns all contribute in different proportions from person to person.

Carpal tunnel syndrome can also travel with medical conditions that increase swelling, affect nerves or change tissue quality: diabetes, thyroid disease, rheumatoid arthritis, kidney disease, pregnancy-related fluid retention, obesity and inflammatory disorders. In people with diabetes or an existing neuropathy, evaluation needs particular care, because symptoms may have more than one cause and the pattern of nerve recovery after surgery differs from patient to patient.

Other indications include compression after a wrist fracture or other trauma, thickening of the tissue around the tendons, cysts or masses within the wrist, and anatomical variations that narrow the tunnel. Rarely, acute carpal tunnel syndrome develops suddenly after injury, bleeding, infection or severe swelling; this form threatens the nerve quickly and is treated as an urgent surgical problem.

It is equally important to say what the operation does not treat. Carpal tunnel surgery is not a remedy for every kind of hand numbness. Symptoms centred on the little finger, numbness that begins in the neck or shoulder, widespread tingling in both hands and feet, or pain driven mainly by arthritis each call for a different diagnostic pathway. A release performed for the wrong diagnosis relieves nothing — which is why the assessment stage deserves as much attention as the surgery itself.

How Carpal Tunnel Surgery Is Performed

Preparation Before Surgery

Preparation begins with confirming that carpal tunnel release is actually the right treatment for you. Your physician reviews your symptoms, examination findings, previous treatments, medical history, medications, allergies and any nerve testing or imaging already done. Where earlier records exist, reviewing them first makes the in-person evaluation sharper and avoids repeating tests unnecessarily.

Depending on your age and general health, you may have blood tests and an anaesthesia assessment before the procedure. If you take blood thinners, diabetes medication or immune-modifying treatment, your treating doctors will tell you exactly how to handle these around the operation — this is decided individually, never by a general rule. Factors that can affect healing, such as smoking, poorly controlled blood sugar, active infection or significant swelling, may need attention before a date is set.

Your care team also explains the recommended anaesthesia. Carpal tunnel release is commonly performed under local anaesthesia, regional anaesthesia, sedation or a combination, depending on the surgical approach, your preference and your medical background. Most procedures are done on an outpatient basis: after a period of observation, you return home the same day.

Open and Endoscopic Carpal Tunnel Release

Two established techniques achieve the same release. In open carpal tunnel surgery, the surgeon makes a small incision in the palm near the wrist and divides the transverse carpal ligament under direct vision. In endoscopic carpal tunnel surgery, a small camera and specialised instruments are introduced through one or more limited incisions, and the ligament is released from underneath while the surgeon watches on a screen.

Neither approach is superior for every patient. The choice depends on your anatomy, the severity and character of the compression, any previous wrist surgery or trauma, and the surgeon’s assessment of which method offers the clearest, safest view in your particular wrist. The elements that actually determine a good operation are the same in both: accurate diagnosis, complete release of the ligament, protection of the nerve and surrounding structures, and sensible recovery planning afterwards.

What Happens During the Operation

The sequence on the day is consistent and deliberately unhurried:

1. The team verifies the operative hand, reviews your consent, and prepares the wrist and palm under sterile conditions.
2. Anaesthesia is given according to the agreed plan, and its effect is confirmed before anything else happens.
3. The surgeon makes the incision — in the palm for an open release, or the smaller access points for an endoscopic release.
4. The transverse carpal ligament is carefully divided while the median nerve, tendons and nearby blood vessels are protected. The moment the release is complete, the pressure inside the tunnel falls.
5. The incision is closed with sutures or skin-closure materials and a dressing is applied. Some patients receive a light bandage; others have a splint for comfort and protection, depending on the surgeon’s judgement.
6. You are observed in recovery, given wound-care and activity instructions, and discharged once the team is satisfied.

How long does carpal tunnel surgery take?

The release itself is brief — operating time is commonly well under half an hour, and a straightforward release can take considerably less. Your total time at the hospital is longer, because it includes preparation, anaesthesia, a period of observation afterwards, medication review and discharge instructions; plan for a matter of hours rather than minutes, even for a day procedure. Brevity in the operating room should not be mistaken for simplicity: the structures involved are delicate, and the care taken during those minutes is what protects the nerve.

Technology and Diagnostic Support

Modern carpal tunnel care rests on accurate diagnosis and clear visualisation rather than any single device. Nerve conduction testing establishes the severity and location of the compression before a scalpel is ever considered. Ultrasound helps evaluate nerve swelling, tendon changes, cysts or structural concerns in selected patients, and higher-resolution imaging is reserved for wrists made complex by previous trauma or surgery. In the operating room, magnification, refined hand instruments, endoscopic visualisation where used, and continuous anaesthesia monitoring support precision. The purpose of the technology is not to make an incision smaller for its own sake; it is to let the surgeon see clearly, protect delicate structures and match the approach to your anatomy.

After the Procedure

You are monitored until you are ready for discharge. Discomfort is managed with the medications your team prescribes or recommends, together with elevation and limited use of the hand. Most patients can use the fingers for light tasks soon after surgery — early finger movement is actively encouraged to prevent stiffness — but gripping, pushing, lifting and forceful wrist motion are restricted while the wound heals.

Before you leave, the team goes through wound care, dressing changes, safe hand positioning, the warning signs of a wound problem — such as spreading redness, discharge, fever, severe swelling or pain that worsens rather than settles — and the timing of your follow-up. Sutures, where used, are removed once the incision has healed sufficiently. Hand therapy is added when there is stiffness, scar sensitivity or weakness, or when your work places heavy demands on the hand.

Why Acting Early Matters

Carpal tunnel syndrome is a nerve compression condition, and nerves respond to pressure on a timeline. A nerve irritated for a short period usually recovers well once the pressure is removed. A nerve compressed for months or years loses some of its capacity to recover at all. Persistent pressure can end in constant numbness, reduced coordination, loss of grip and pinch strength, and wasting of the muscles at the base of the thumb — changes that a technically flawless operation cannot always undo.

Delay also costs you in quieter ways. Some people adapt unconsciously: they use the other hand more, avoid certain tasks, accept broken sleep as normal. By the time weakness becomes obvious, the nerve may already be significantly affected, and the window for a complete result has narrowed.

Early assessment does not mean early surgery. It means establishing how severe the compression is and choosing the right treatment at the right time. Mild cases can be managed conservatively and monitored with a clear conscience. Moderate or severe cases benefit from a surgical discussion before the nerve changes become advanced. Either way, the decision is made from information rather than from waiting.

Benefits of Carpal Tunnel Surgery

When release surgery is recommended after a thorough evaluation, the expected benefits centre on relieving nerve pressure and restoring hand function over time — not overnight transformation, but a mechanical problem addressed at its source.

Benefit	What It Means for You
Reduced nerve compression	The ligament release creates more room for the median nerve, addressing the underlying mechanical cause of symptoms.
Improvement in night symptoms	Many patients experience less night-time numbness, tingling and hand discomfort, which can support better sleep.
Better hand sensation	As the nerve recovers, tingling and numbness may decrease, although recovery can take longer in severe or longstanding cases.
Improved grip and daily function	Patients may regain confidence with tasks such as holding objects, typing, cooking, dressing and using tools.
Prevention of further nerve deterioration	Timely surgery may help reduce the risk of progressive weakness or permanent nerve changes in patients with significant compression.
Outpatient treatment in many cases	Carpal tunnel release is commonly performed without an overnight hospital stay, supporting a shorter medical visit for suitable patients.

How Long Is Recovery from Carpal Tunnel Surgery?

Most people are using the hand for light tasks within days, back to desk-based activity within a few weeks as comfort allows, and rebuilding grip strength over the following two to three months — while the nerve itself can continue recovering for many months after that. The exact pace depends on how severe the compression was before surgery, the technique used, your general health, and what your hands do all day. The pattern, however, is broadly consistent:

Time Period	What Patients Can Expect
Day 1	The hand is bandaged, and patients are encouraged to elevate the hand and gently move the fingers. Numbness from anaesthesia may take time to wear off. Light finger use is usually allowed, but lifting and gripping are avoided.
First Week	Incision care is important. Soreness, swelling, bruising and palm tenderness are common. Night symptoms may improve early for some patients, while numbness may take longer to change.
First Month	Stitches may be removed once the wound is ready. Patients gradually increase light hand use. Driving, office work and daily activities depend on comfort, hand control and the surgeon’s advice.
Two to Three Months	Grip strength and endurance usually continue to improve. Some patients may still have scar sensitivity or palm discomfort, particularly with pressure or heavy use.
Longer Term	Nerve recovery can continue for several months. Patients with severe preoperative nerve compression may need more time, and some residual numbness or weakness may persist if nerve damage was advanced before surgery.

How should you sleep after carpal tunnel surgery?

Keep the operated hand elevated and off duty. For the first nights, rest the hand on a pillow so it sits above the level of your heart — this reduces swelling and throbbing. Avoid sleeping on the operated arm, avoid letting the hand hang off the edge of the bed, and keep any splint or bandage in place exactly as instructed. A few gentle finger movements before settling can ease stiffness. If you were a wrist-curler before surgery, the same neutral position that a splint enforces is the position to aim for now; it keeps pressure in the healing tunnel low and tends to make the nights noticeably easier.

Returning to work, driving and daily life

Timing depends on what your hands do. Light desk work with a bandaged hand is often possible within days to a couple of weeks, provided you can position the hand comfortably and avoid pressure on the palm. Manual work involving gripping, lifting, vibration or repeated force takes longer, and your surgeon will set the milestones with your specific job in mind. Driving returns when you can control the wheel confidently, react without hesitation and are no longer taking medication that impairs you — comfort behind the wheel is the test, not the calendar alone. Household tasks scale up the same way: fingers first, palm pressure and grip last.

Risks and Possible Complications of Carpal Tunnel Surgery

Carpal tunnel release is a well-established procedure with a long safety record, but no operation is entirely free of risk, and an honest discussion of the possible complications belongs in every consent conversation. Most problems after a release are minor and temporary; serious complications are uncommon when the diagnosis is correct and the anatomy is respected.

The issues surgeons discuss most often include:

• Wound problems — infection, delayed healing or bleeding under the skin, usually manageable with straightforward wound care when they occur.
• Scar tenderness — sensitivity along the incision that typically softens over weeks to months, sometimes helped by scar massage and hand therapy.
• Pillar pain — a deep ache in the palm on either side of the released ligament, aggravated by pressure or gripping, which generally settles gradually as the tissues remodel.
• Temporary weakness — grip and pinch strength commonly dip in the early weeks before rebuilding, which is an expected part of healing rather than a complication in itself.
• Nerve or vessel injury — damage to the median nerve, its small branches or nearby structures is rare but real, and it is the reason clear visualisation and surgical experience matter so much in this operation.
• Incomplete release or persistent symptoms — if part of the ligament is left undivided, or if the symptoms had an additional cause elsewhere, numbness and tingling can continue and further assessment is needed.
• Complex regional pain syndrome — a rare, exaggerated pain response after hand surgery that requires early recognition and dedicated treatment.

Stiffness of the fingers and wrist can follow any hand operation, which is exactly why early, gentle finger movement is encouraged from the first day. Understanding these possibilities beforehand is not meant to alarm you; it allows you to weigh a small, well-defined set of risks against the well-understood consequences of leaving a compressed nerve under pressure.

Can carpal tunnel come back after surgery?

True recurrence is uncommon. Once the transverse carpal ligament heals in its lengthened position, the tunnel remains permanently larger, and most patients who improve after surgery stay improved. When symptoms do return or persist, the explanation is usually one of three things: the release was incomplete, the original symptoms had an additional source — such as nerve compression at the neck or a peripheral neuropathy — or the nerve was so severely damaged before surgery that full recovery was never anatomically possible. New compression can occasionally develop years later, particularly in people with conditions such as diabetes, thyroid disease or inflammatory arthritis that continue to affect the tissues around the nerve. Persistent or returning symptoms after a release deserve careful re-evaluation, often including repeat nerve testing, before any decision about further treatment.

Factors That Influence Outcomes

The result of carpal tunnel surgery depends on more than the procedure itself. A good outcome begins with confirming that the symptoms are truly caused by median nerve compression at the wrist. If your numbness is partly driven by neck disease, diabetic neuropathy, ulnar nerve compression or another condition, surgery may relieve the carpal tunnel component without relieving everything — which is precisely why careful assessment and, where appropriate, nerve conduction testing come before any operating date.

Symptom duration matters. Patients with intermittent numbness and preserved strength generally recover faster and more completely than those with constant numbness, severely abnormal nerve tests or muscle wasting, because longstanding compression leaves the nerve with less capacity to regenerate. Age, diabetes, thyroid disease, inflammatory arthritis, smoking, nutritional status and general circulation all influence healing and nerve recovery as well.

Technique and aftercare carry their share. Precise, complete release of the ligament, protection of nearby structures, appropriate wound closure and clear recovery instructions make the process safer and more predictable. You have an active role too: keeping the incision clean, attending follow-up, avoiding early overuse, moving the fingers as advised, and flagging anything unusual to your care team promptly.

Expectations should be honest. Pain and night-time tingling often improve relatively early. Sensory recovery is gradual. Grip strength typically dips temporarily after surgery and rebuilds over weeks to months. In advanced cases, the purpose of surgery is partly to improve symptoms and partly to stop further decline, even when complete reversal of numbness or weakness is no longer possible. That distinction is worth understanding before you consent, not after.

A good outcome, in other words, is measured by accurate diagnosis, nerve protection, sound wound healing and restored function matched to your life — not by the length of the incision or the speed of the operation.

Carpal Tunnel Surgery at Acibadem

Carpal tunnel release is often a short procedure, but the decision around it deserves the same rigour as a larger operation: accurate diagnosis, experienced surgical judgement, appropriate anaesthesia planning and clear recovery guidance. That is how care is organised at Acibadem hospitals.

Evaluation involves physicians from the specialties relevant to each case — hand surgery, orthopaedics, neurosurgery, neurology, physical medicine and rehabilitation, radiology and anaesthesia. Hand surgery is practised within both orthopaedic and plastic and reconstructive surgery traditions, and more complex cases — where symptoms overlap with cervical spine disease, diabetic neuropathy, inflammatory arthritis, previous trauma or compression at more than one site — can be discussed in multidisciplinary settings before a plan is fixed.

The diagnostic pathway avoids assumptions. Existing test results are reviewed carefully rather than repeated by default; where testing is incomplete or the symptom pattern is atypical, additional nerve studies, ultrasound, imaging or specialist assessment may be recommended. The aim at that stage is deliberately open-ended: to establish whether a release is likely to help, whether non-surgical treatment is still the reasonable path, or whether a different diagnosis explains the symptoms better.

Technique is chosen per patient, not per policy. Where endoscopic release suits the anatomy, minimally invasive visualisation can reduce soft-tissue disruption; where open release offers the safest or most complete view, it remains the reliable standard. Neither is treated as the default for everyone.

Personalisation runs deeper in hand surgery than in most fields, because people use their hands so differently. A musician, an office professional, a mechanic, an athlete, a parent lifting young children, or someone with symptoms in both hands each needs different timing, rehabilitation advice and return-to-work planning. The team plans around the function you need back, not just the ligament being released.

Second-opinion reviews — of the diagnosis, the severity of compression, previous treatment and the proposed approach — form part of this work as well. They are most valuable when symptoms are severe, when surgery has been recommended urgently, when the picture does not match classic carpal tunnel syndrome, or when earlier treatment did not deliver what was expected.

Deciding Whether Surgery Is the Right Step

Carpal tunnel syndrome is disruptive, sometimes painful, and occasionally career-threatening — but it is also one of the best-understood nerve compression conditions in medicine, with a clear diagnostic pathway and a well-defined operation at the end of it for those who need one.

The sequence that serves patients best is consistent. First, confirm that the median nerve at the wrist is genuinely the source of the symptoms. Second, use proportionate conservative treatment where the severity allows it. Third, consider release surgery when symptoms persist, when testing shows meaningful compression, or when weakness appears — and consider it before the nerve changes become permanent rather than after. Decisions made in that order tend to hold up, whatever the final answer turns out to be. The earlier the severity of compression is established, the wider the range of good options remains — and that knowledge, more than anything else, is what keeps the decision in your hands.