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Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a set of symptoms that arises due to compression of the median nerve at the wrist. The median nerve supplies sensation to the thumb, index, middle and part of the ring finger.

What are the symptoms of carpal tunnel syndrome?

When the median nerve is compressed at the wrist the most common symptoms are those of pins and needles and numbness in these digits of the hand. Patients quite often wake up at night and have to either elevate the hand or shake  it vigorously until the tingling subsides.

Symptoms can be most marked by gripping objects such as newspapers, books, the telephone or the steering wheel of a car. The hand can be painful and the symptoms are severe enough to disrupt work, leisure activities and sleep.

What are the common causes of carpal tunnel syndrome?

In a significant number of patients is not possible to identify an obvious cause for median nerve at compression and in these cases carpal tunnel syndrome is regarded as being idiopathic.

However, pressure on the median nerve at the wrist can be due to an injury with bleeding or swelling, inflammation of the tissues around the tendons, arthritis, thyroid disease, pregnancy and rarely kidney failure.

How is carpal tunnel syndrome treated?

Early symptoms in mild carpal tunnel syndrome may respond to rest, activity modification, splinting or an injection into the carpal tunnel to reduce the inflammation around the median nerve.

If the symptoms persist or if there are definite clinical signs such as a positive Tinel's sign, Phalen's test, persistent numbness or wasting of the muscles of the thumb then further investigations such as an electrical test for the function of the nerve and surgery are indicated.

What does surgery for carpal tunnel syndrome involve?

Surgery for carpal tunnel syndrome is called carpal tunnel decompression and can be carried out under local anaesthetic or occasionally under general anaesthetic. It involves a small incision in the palm through which a tight ligament causing pressure on the median nerve is released. A few fine sutures are placed on the skin and a dressing is applied which supports the wrist.

Exercises to regain movement of the fingers are started the day after surgery and the dressing is usually removed at 48 hours. Sutures are removed approximately 10 to 14 days after the operation.

What are the difficulties that patients can face following the procedure?

Just like any other operation, carpal tunnel decompression can result in problems such as bleeding, infection or delayed healing of the wound. Depending upon the severity and duration of the problem, the symptoms may not disappear completely or may improve significantly and then recur.

It is not uncommon for patients to experience tenderness in the scar or on either side of the scar for a period of 6 to 12 weeks following the surgery. Movement can also be slow to return and if there is a significant problem with pain and stiffness then Hand Therapy for a period of time is essential.

How long does it take to recover following the operation?

Most patients regain reasonable mobility between 2 and 4 weeks after the operation but it takes longer to regain grip strength and power in the hand.

Depending upon the type of job and the demands of travelling, return to work can be anticipated between 2 to 6 weeks following surgery except in patients who do heavy manual work, use vibrating tools or have to lift heavy weights.

Surgical treatment

This procedure only requires a local anaesthetic, which means that the area being operated on is numb and you are awake for the approximately 45 minutes that the surgery takes.

Your hand will then be bandaged for 48 hours, after which time you will be asked to remove the dressings and use your hand as normal within the constraints of any post-operative discomfort.

You will be given painkillers and your arm will be elevated in a sling. The stitches will be removed around the 10 day point.

After the operation

Please refer to the hand therapy exercise sheet for patients who have undergone carpal tunnel decompression. The fingers must be kept moving to decrease swelling and patients should observe a 6 week rest period from sport and heavy lifting. Normal activities, such as driving, may be resumed as soon as you are comfortable.

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I have no symptoms, they've gone, and I can do everything I could do before.


Please view the video interview with a patient who has undergone this procedure.

I have no symptoms, they've gone, and I can do everything I could do before.


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