Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is caused by the compression of the median nerve as it passes under a tight strap on the front of the wrist.

Anyone can be affected but it is more common in women and in any condition that decreases the space in the tunnel under the strap. Local injury, tenosynovitis (swelling around the tendons), arthritis, diabetes, thyroid disease, being overweight and pregnancy are commonly implicated but a cause is often not identified.

Symptoms

Sufferers may experience a feeling of ‘pins and needles’ or tingling in the thumb, index and middle fingers. This is often worse at night, if reading a newspaper or while driving. The fingers may feel ‘dead’. Pain in the hand, wrist or arm often occurs. Later on, the hand feels clumsy and weak and dextrous tasks (doing buttons up etc) become difficult.

Investigation

A good patient history and examination is often sufficient to make the diagnosis. Other conditions can mimic carpal tunnel syndrome and may need to be excluded with x-rays or blood tests. Electrical tests of the nerves can help confirm diagnosis.

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Carpal Tunnel Syndrome

Rest and treating exacerbating factors may resolve mild symptoms. A splint to hold the wrist straight at night can be helpful and may provide long term relief on occasion.

A local anaesthetic and steroid injection around the nerve in the carpal tunnel can reduce swelling and relieve pressure for 80% patients, although 80% of those will have a recurrence of symptoms within a year.

For patients who have persistent, intrusive symptoms or start to develop numbness in the finger tips continuously, a small operation is usually recommended.

This is nearly always carried out under local anaesthetic as a day case and reliably relieves pressure symptoms. The operation involves dividing the tight strap at the wrist so allowing the nerve more room.

In severe cases finger numbness can persist following surgery but the ‘pins and needles’ sensation and night discomfort is relieved.

Carpal Tunnel Syndrome

After carpal tunnel surgery you will have a small adhesive dressing over the wound and a padded bandage around the wrist. Your fingers and thumb will be free to move and you are encouraged to move them immediately after the operation.

You will need to keep the hand and arm elevated for a few days after the surgery to avoid swelling but it can be used for light activities.

After 2 days the padded bandage is removed but the wound is kept covered and must be kept clean and dry until the stitches are removed 2 weeks after the operation.

Once the wound has healed massaging the scarred area with some hand cream can help soften the scar and make it more comfortable.

Most people return to work once the stitches have been removed but it might be sooner for those with light jobs or longer (up to six weeks) for those with physically demanding occupations, such as manual labourers.

Driving can be undertaken when you feel safe to control the car, but most people avoid this for the first two weeks or until the wound is healed.