Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome refers to pain, tingling, or numbness in one or both hands. It is the result of the median nerve in the wrist being compressed. Carpal tunnel symptoms are often worse at night, and often improve by shaking the hand.

This problem is diagnosed by a combination of clinical assessment and nerve conduction studies.

In some cases, such as during pregnancy, carpal tunnel syndrome may resolve on its own. However in many patients, the problem requires surgery.

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How is it treated?

Carpal tunnel syndrome often responds to analgesia, the use of a hand splint at night, and the avoidance of aggravating activities, such as the operation of vibrating objects (e.g. jackhammers).

In cases which do not respond to conservative measures, surgery may be required. This operation is frequently performed by neurosurgeons, and is known as a carpal tunnel decompression.

How is the surgery performed?

A week or two before surgery you will have some blood tests to check a number of things, including that your blood is clotting correctly.

On the day of your surgery you will be admitted to hospital an hour or two before your surgery time. You should not eat or drink anything for 6 hours before this.

A specialist anaesthetist will give you some light sedation, and your palm will be administered with local anaesthetic. You will also have some antiseptic solution painted on your hand. A small incision will be made in your palm, usually in a skin crease. Using magnification, your surgeon will carefully divide the tissues which are compressing the nerve. This will take around 20 minutes. Once the nerve is lying freely without any constriction, the skin is closed and a dressing applied.

What happens after the operation?

You should keep your hand elevated for the first 48 hours after surgery. You will have to wear a hand bandage for 4 days. On day 4 you should have an appointment with your GP who will check your incision.

Around 12 days after surgery your sutures will be removed by your GP’s Nurse or the Precision Brain Spine and Pain Centre Nurse.

You will be able to use your hand in a progressively normal fashion. You should avoid repetitive hand movements, direct pressure over the incision, and heavy lifting for at least 3 months after surgery.

You will be given more detailed instructions about incision care before your surgery.

Are there any risks?

Like any type of surgery there is a chance of developing a complication. These risks are low in carpal tunnel surgery.

The most common complications are wound infection (treated with antibiotics) and haematoma (blood clot).

There is a very small risk (less than 1 in 100) of damage to the nerve, which may cause permanent weakness and/or numbness. Another uncommon complication is "bowstringing" of the tendons in the hand, which may require hand therapy and/or further surgery to rectify.

Another postoperative problem that sometimes occurs is wound hypertrophy, or thickening. In most cases the tenderness associated with the wound settles down over several months and does not cause any long-term problems.

What are the results of surgery?

Carpal tunnel decompression is successful for most patients. Complications occur in a very small minority.