Carpal Tunnel Syndrome

Carpal tunnel syndrome affects the hand and wrist. It is due to compression, inflammation or irritation of the median nerve as it passes through the carpal tunnel. The carpal tunnel is a narrow passageway in the wrist formed by bones and a ligament, the transverse carpal ligament. Within the carpal tunnel are flexors tendons that bend your fingers and your thumb as well as the median nerve. The median nerve supplies muscles and sensation to your hand.

What makes carpal tunnel worse? The exact cause of carpal tunnel syndrome is not always clear, but it is often associated with a combination of factors, including:

Repetitive Hand and Wrist Movements

Repetitive hand and wrist activities, such as typing, using vibrating tools, manual work or playing certain musical instruments, can increase the risk of developing carpal tunnel syndrome.

Wrist Anatomy

Certain anatomical factors can contribute to carpal tunnel syndrome. In some patients, the median nerve may be split into two nerves or may be accompanied by an additional artery that can lead to nerve compression. Previous injuries, such as a wrist fracture, can alter the alignment of your bones, narrow the space for the median nerve and lead to nerve compression.

Nerve-Related Conditions

Certain medical conditions, such as diabetes, rheumatoid arthritis, thyroid disorders, or fluid retention during pregnancy, can increase the risk of developing carpal tunnel syndrome.

Hormonal Changes

Hormonal changes, such as those that occur during pregnancy or menopause, can lead to fluid retention and swelling and potentially lead to compression of the median nerve.

The classical symptoms of carpal tunnel syndrome are:

• Numbness, tingling, or “pins and needles” affecting the thumb, index finger, middle finger, and half of the ring finger.
• Hand or wrist pain that typically worsens with activity or during the night. If you have night symptoms, you may need to shake your hand or run cold water over it to find some relief.
• Weakness or clumsiness in the hand, making it difficult to grip objects or perform fine motor tasks. This can include opening doorknowbs or butting up clothes.
• Sensation of swelling or fullness of your fingers, despite no visible swelling.

The symptoms of carpal tunnel syndrome often start gradually and may initially appear during nighttime or activities that involve repetitive hand movements. Carpal tunnel syndrome is frequently seen in both hands, although the dominant hand is typically affected first. While carpal tunnel does not “heal itself, your symptoms may come and go depending how severe your carpal tunnel is and what activities you are doing. Over time, symptoms tend to become more frequent and severe. If you had severe capal tunnel syndrome for a while, your muscles is your hand, especially those forming the base of your thumb, may get wasted.

Do you need surgery for carpal tunnel syndrome?

Surgery for carpal tunnel syndrome is a more definitive treatment option. It is generally recommended in the following circumstances:

• You have tried non-operative treatment measures, but are getting persistent symptoms affecting your daily activities and you work.
• You have progressive symptoms. This may be worsening pain, numbness and weakness of your hand.
• You are getting consistent night time symptoms and cannot get enough sleep.

What surgery can be done for carpal tunnel syndrome?

There are two main types of carpal tunnel surgery: open carpal tunnel and endoscopic (key-hole) carpal tunnel surgery. Both procedures are effective ways to relief your symptoms and aim to alleviate the pressure on the median nerve in the wrist.

Open carpal tunnel release:

This is the traditional and most commonly performed procedure for carpal tunnel release. It involves making a small incision in the palm of the hand. After the carpal tunnel ligament is released, the incision is closed with sutures and a bulky dressing is applied. The sutures need removal in 2-3 weeks. You need to protect your wound during that period and avoid excessive use of your hand and wrist as the skin in your palm needs time to heal.

Endoscopic (key-hole) carpal tunnel release:

In endoscopic carpal tunnel surgery, a small (around 5mm) incision is made in the forearm at the wrist level. This incision is used for a specialised camera (endoscope) to be passed into your carpal tunnel. With the camera, the transverse carpal ligament can be seen and released without cutting the skin in your palm. There are several advantages of key-hole carpal tunnel surgery compared with open surgery. The ligaments forming the top of your carpal can frequently be better seen than with open surgery and released more effectively. The other benefit is that without the incision in your palm, return to work and other activities, such as sports, may be quicker with endoscopic carpal tunnel surgery. In some instances, endoscopic carpal tunnel surgery may not be possible and this is best discussed during your consultation.

Recovery after carpal tunnel surgery depends on what surgery you had, what work you do and whether it is your dominant hand that had surgery. It is usually recommended to take 2 weeks off from work after carpal tunnel surgery. You may need to take up to 6 week time off work if, for example, it is your dominant hand and your job involves a lot of manual work.

You should wait 24hrs before flying after surgery and you may need to wait 1-2 weeks before returning back to driving.