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Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?
Carpel Tunnel Syndrome is caused by pressure on the median nerve, (the main nerve into the hand), at the wrist. The median nerve supplies the thumb, index, middle and half of the ring finger; sometimes there are slight variations to this. Symptoms include tingling or numbness or pain in the hand and fingers. Symptoms tend to be worse at night and can be relieved by shaking the hand.

Medical conditions can be associated with carpal tunnel syndrome – these include diabetes, pregnancy, thyroid disorders, rheumatoid arthritis and wrist injuries. In severe cases it can cause wasting of the muscles of the thumb.

How is it diagnosed?
It is usually clear from the history if the median nerve is being compressed. On examination the direct nerve compression test is used to confirm the diagnosis. Tapping on the nerve usually reproduces the patient’s symptoms.

Nerve Conduction studies are used to confirm the diagnosis and measure how severely the nerve is being pressed. Nerve studies also confirm that no other nerves are being pressed in the arm. Nerve conduction studies can be performed at the time of initial consultation as part of the '1 Stop Carpal Tunnel Service' provided by shoulderelbowhand.

Non Operative Treatment
If symptoms are mild then you may benefit from wearing a splint which holds the wrist in slight extension which takes the pressure of the nerve. Injections to the carpal tunnel can provide symptomatic relief.

Operative Treatment
If symptoms persist and are troublesome then surgery can be considered. Surgery is performed as a day case procedure and under local anaesthetic (you will be awake but not feel pain). A tourniquet, tight blood pressure cuff, is worn on the upper arm to stop bleeding. The transverse carpal ligament is divided and the nerve examined. The carpal tunnel is then examined to make sure there are no other disorders which need treatment. The skin is sutured with fine stitches and a bulky dressing applied.

Post Operative Treatment
The bulky dressing is removed after 24-48 hours and the wound kept clean, dry and covered until the sutures are removed – approximately 7 days. The hand should be elevated and the fingers mobilised. Most patients notice benefit after 1-2 weeks but the recovery can take up to 3 months. The longer the nerve has been pressed pre surgery the longer recovery will take. The scar can be tender to touch and pressure on the scar may be uncomfortable for 6-8 weeks. Gentle massage of the scar once healed should help the scar.

Complications
Usually 95% of patients are happy with the results, in a small number complications can occur:

Infection – less than 1%

Failure of symptoms to resolve – this may be due to prolonged compression of the nerve, the longer the nerve pre operatively the longer it will take to recover

Pillar pain – This is ongoing pain at the front on the wrist

Numbness – This may be related to the scar or over the palm area

Chronic Regional Pain Syndrome – less than 2% – this can occur after surgery or after hand trauma and results in painful and stiff hand with changes. Usually improves with time but can take up 12 months

Mr Sameer Singh's specialist areas