Carpal Tunnel Syndrome

The hand has three main nerves that control the muscles and allow touch called the median, ulnar and radial nerves. The median nerve enters the hand at the level of wrist crease going through a rigid space called the carpal tunnel, accompanied by some of the tendons to the fingers. It gives sensation to the thumb, index, middle and half of the ring finger and moves the thumb. When this tunnel becomes too tight, the median nerve is squashed  leading to carpal tunnel syndrome. Carpal tunnel decompression surgery works by dividing the roof of the tunnel which allows the tunnel to expand thereby taking pressure off the nerve.

Symptoms

If you have carpal tunnel syndrome you probably experience tingling or pins and needles, numbness and sometimes pain in the thumb, index, middle and ring fingers. This may wake you up at night. Many patients find shaking their hand gives temporary relief. As the condition progresses, performing intricate tasks becomes more difficult, and you  may find yourself dropping things and losing grip strength.

Diagnosis

I make the diagnosis mainly on the basis of your symptoms and from careful examination of your hands.  Occasionally I require confirmation of the diagnosis in which case I will arrange for you to have ‘nerve conduction studies’.  I often recommend a steroid injection into the carpal tunnel. Many patients experience temporary improvement in symptoms following injection and this suggests surgery is likely to be beneficial.

Treatment

In the very mild cases often no treatment other than pain killers and/or wearing a splint at night is required. However, in moderate to severe cases I recommend surgery to treat the symptoms and prevent the condition getting worse.

Surgery

This is performed under local or general anaesthesia. The tightness of carpal tunnel is released through a small incision in the palm. You will go home the same day with a bulky bandage which is then replaced with a small sticky plaster after 48 hours. You can return to driving  and light manual work after two weeks, and heavy manual work six weeks after the operation. It may take up to three to six months to see the full benefit of the operation.

Complications

Pain and swelling in the palm of the hand are expected for several weeks after surgery. Wound infection and painful scars occur in less than 5% of patients, rarer complications are poor relief of symptoms, nerve damage causing weakness of the thumb and  complex regional pain syndrome NHS Information on CRPS . I will discuss these with you in more detail at your consultation.

Please see this publication Mr Baker has written on the subject (link to attached paper).