Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition that affects the hand and wrist, characterised by the compression 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, and it houses the median nerve as well as tendons that control finger movements.

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

  1. Repetitive Hand and Wrist Movements: Engaging in repetitive hand and wrist motions, such as typing, using vibrating tools, or playing certain musical instruments, can increase the risk of developing carpal tunnel syndrome.
  2. Wrist Anatomy: Certain anatomical factors can contribute to carpal tunnel syndrome. For example, a smaller carpal tunnel or a wrist fracture that alters the alignment of the bones can narrow the space and compress the median nerve.
  3. 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.
  4. Hormonal Changes: Hormonal changes, such as those that occur during pregnancy or menopause, can lead to fluid retention and swelling, potentially causing compression of the median nerve.
carpal tunnel syndrome

Carpal Tunnel Syndrome

Carpal tunnel syndrome is compression of the median nerve at the wrist. This may cause pain, numbness and hand weakness

wrist pain

Wrist Pain

Wrist pain can be caused by a variety of conditions, including carpal tunnel syndrome

Symptoms

The symptoms of carpal tunnel syndrome may include:

  • Numbness, tingling, or a “pins and needles” sensation in the thumb, index finger, middle finger, and half of the ring finger.
  • Hand or wrist pain that may radiate up the forearm.
  • Weakness or clumsiness in the hand, making it difficult to grip objects or perform fine motor tasks.
  • Sensation of swelling in the 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. Over time, symptoms can become more frequent and severe.

Treatment

Treatment for carpal tunnel syndrome depends on the severity of symptoms and their impact on your daily activities. Mild cases may be managed with conservative measures such as:

  • Wrist Splinting: Wearing a splint to keep the wrist in a neutral position can help relieve pressure on the median nerve and reduce symptoms, especially at night.
  • Activity Modification: Avoiding or modifying activities that worsen symptoms, taking regular breaks, and practicing ergonomic techniques can be beneficial.
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter pain relievers and anti-inflammatory medications may help reduce pain and swelling.
  • Corticosteroid Injections: In some cases, a corticosteroid injection into the carpal tunnel can provide temporary relief of symptoms.

Surgery for Carpal Tunnel Syndrome

If conservative measures do not provide sufficient relief or if the condition is severe, surgery may be recommended. There are two primary types of carpal tunnel release procedures: open carpal tunnel release and endoscopic carpal tunnel release. Both procedures aim to alleviate the pressure on the median nerve in the wrist by cutting the ligament that forms the roof of the carpal tunnel, thus increasing the space within the tunnel.

  1. 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. Following the ligament release, the incision is closed with sutures that need removal in two weeks and a bandage is applied to support the hand during healing.
  2. Endoscopic Carpal Tunnel Release: Endoscopic carpal tunnel release is a minimally invasive procedure that uses a small instrument called an endoscope to visualize the structures within the carpal tunnel. This procedure requires one smaller incision, typically less than 1cm long, made at the wrist area. The endoscope, equipped with a camera and specialized surgical tools, is inserted through one incision, allowing the surgeon to visualize the carpal ligament and safely cut it using the instruments inserted through the second incision. The endoscopic approach offers the advantage of smaller incisions, potentially faster recovery, and reduced postoperative discomfort for some patients.
keyhole carpal tunnel release

Keyhole release

Through a small incision a specialised camera is used to release the carpal tunnel.

endoscopic carpal tunnel release

Endoscopic release

A specialised camera is used to look a the carpal tunnel and to perform the release with a precision scalpel

endoscopic carpal tunnel release view

Endoscopic view

This is an example of an endoscopic release of the carpal tunnel as viewed through the keyhole camera.

Get Expert Help

If you have wrist pain or have carpal tunnel symptoms, it is important to get your wrist evaluated and perform appropriate diagnostic tests. Dr. Arthur Turow will provide personalised recommendations and guide you through your treatment.

Please use above information as a guide only. More detailed information specific to your condition and your recovery will be given in your consultation with Dr. Arthur Turow, who will also provide additional resources to supplement your discussion. For more information, please contact the rooms of Dr. Arthur Turow on (08) 8236 4179.