Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) is a condition is increased pressure on the median nerve at the wrist causes problems. The median nerve runs in a tunnel formed by bones and ligaments, the tunnel also contains the tendons that bend your fingers and thumb. The increase in pressure can be caused by a number of different conditions but in most cases there is no particular identifiable cause.
What are the symptoms?
The main symptom is of a feeling of “numbness”, “pins and needles” or “tingling” in the hand. This is often worse at night or in the morning. It may be brought on by activities that involve gripping or holding. Other symptoms include pain in the wrist and/or hand, gradually losing the sensation of touch and weakness of grip. Patients often describe difficulty holding small objects such as buttons or coins and of dropping things they thought they had hold of.
Symptoms may progress over time. If not treated the longer the nerve is compressed the more potential and lasting damage can occur to it.
What are the treatments?
For mild symptoms a wrist splint may help to limit the compression and improve the symptoms. Steroid injections can be given but the symptoms tend to return after a number of weeks or months. Surgery is often needed to provide a lasting treatment.
CTS associated with pregnancy usually goes away after the baby is born.
What does the operation involve?
Carpal tunnel decompression is usually performed under local anaesthetic. A small incision in the palm is made and the thick ligament that forms the roof of the carpal tunnel is released (see pictures below) releasing the pressure on the nerve.
What is the recovery?
The surgery is performed as a day case procedure and patients are usually discharged home a few hours after surgery. The small (3-4cm) cut in the palm has stitches in and a dressing over the top. You can use the hand for most day-to-day activities straight away but the wound must be kept clean and dry until the stitches are removed at 7-10 days.
Return to work depends on the type of job; desk based work may be done within 1-2 weeks but manual work should be avoided for 4-6 weeks.
What are the outcomes?
The surgery is usually very successful (around 90%). The tingling and pain usually go within a few days of the procedure. Where the condition is more severe or there is already loss of sensation or muscle power the recovery will take longer and may not be complete. It may take around 3 months to get back to full strength.
What are the possible complications of surgery ?
All surgical procedures have risks/complications that may occur despite the highest standards of practice and it is not practical to list them all. What follows is a list of some of the problems that can be encountered following carpal tunnel surgery. These complications are rare but it is vital that you are aware of them in order for you make an informed choice about the operation knowing the risks and benefits of surgery.
The operative site may become infected – this can usually be treated with antibiotic tablets.
There may be a small amount post-operative bleeding.
Wound healing problems;
The wound may take longer than usual to heal or may not heal as expected.
The median nerve may be damaged – if this is the case the muscles or sensation supplied by the nerve may stop working, if this does occur it usually recovers over a period of time but it may be permanent.
Wrist Pain/Painful Scar;
Pain usually settles within the first 2 weeks but the scar may be painful for 6-8 weeks, sometimes there may be persisting pain on the operated side of the wrist.
The hand and fingers may become stiff but this can be avoided by early movement exercises.
Severe pain and stiffness;
Complex Regional Pain Syndrome is a risk with any hand surgery and often requires prolonged treatment with physiotherapy and painkillers.
All surgical procedures may cause complications that could result in a situation that is worse than before the surgery – these complications are extremely rare.
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