Carpal Tunnel Syndrome

What is it?

Carpal tunnel syndrome is the sensation of numbness, tingling and pain in the hand due to the compression of the median nerve as it passes through a tight tunnel at the wrist.

Who gets it and what causes it?

There are a number of ways that the nerve can be compressed at the wrist. Osteoarthritis and fractures at the wrist may cause the space around the nerve to be narrowed. Inflammation of the lining around tendons lying next to the nerve known as tenosynovitis is another possible cause. Other conditions associated with carpal tunnel syndrome are pregnancy, thyroid disease, rheumatoid arthritis and diabetes. However, in most cases there is no identifiable causative factor.

What are the signs and symptoms?

The pain, numbness and tingling is usually within a particular distribution (the thumb, index, middle and ring fingers) experienced particularly at night and first thing in the morning. In long-standing cases, there is often loss of grip power and dexterity in the hand. Activities such as picking up coins and fastening buttons may then become difficult.

What tests will I need?

Following a consultation, involving a medical history and clinical examination, you may require X-rays and specialised tests of the nerves and muscles within your hand known as electrodiagnostic tests.

What is the treatment?

Initially we will attempt nonoperative measures such as splinting of the wrist with a brace and the injection of a steroid into the tunnel. Long-standing and/or severe symptoms that interfere with quality of life are likely to require surgical treatment.

What does the surgical treatment involve?

Surgery aims to relieve any pressure within the carpal tunnel through which the nerve travels. It involves releasing a thick ligament (the flexor retinaculum), which forms the roof of the tunnel.

Mr Miller performs carpal tunnel decompression surgery at Claremont Private Hospital. The procedure usually lasts 15-20 minutes as a day case requiring only local anaesthetic. The surgical scar is usually in the region of 2 to 3cm long, and is located at the base of the palm.

What happens after the surgery?

Taking simple painkillers regularly for the first few days after the operation will help to relieve any post-operative pain. Stitches are of the resorbable (dissolving) kind so will not need removal. A wound check will be organised either at your GP practice or at the Claremont Hospital 5-7 days after your operation and a follow-up appointment to see Mr Miller 1-2 weeks after that.

When I can return to normal activity?

You will be able to use the fingers of your hand the same day for light activities of daily living such as holding a utensil or remote control.

If you perform heavy manual work it is advised to stay off work for 3-6 weeks; otherwise a period of 2-3 weeks off work is recommended to allow your wound to heal without undue pressure. You are advised not to drive for 1-2 weeks after surgery.

A return to physical exercise and contact sports will be discussed and tailored to each individual, however most activities can resume after the wound has healed. Activities involving heavy lifting and contact at the operative site can commence after 4 to 6 weeks.

What are the complications of surgery?

Carpal tunnel decompression is considered a reliable procedure with a high success rate. You may experience an ache around the site of surgery and painful hypersensitivity of the scar that may last for weeks to months. Grip strength may also take some time to recover. The original symptoms of pain, numbness and tingling may not completely resolve after surgery in some patients. There are small risks of infection (~2%) and nerve injury (<1%). A small percentage of patients (1% or less) will develop a severe reaction after hand surgery (called CRPS), with long-standing pain and loss of use in the hand and something that is difficult to treat. If you are concerned about any of these risks, or have any further queries, please speak to Mr Miller.