You still have symptoms after a long period of nonsurgical treatment. In general, surgery is not considered until after several weeks to months of nonsurgical treatment. But this assumes that you still have symptoms but there's no sign of nerve damage. Nerve damage would make surgery more urgent.
Severe symptoms (such as persistent loss of feeling or coordination in the fingers or hand, or no strength in the thumb) restrict normal daily activities.
There is damage to the median nerve (shown by nerve test results and loss of hand or finger function), or a risk of nerve damage.
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