What is Carpal tunnel syndrome?
Carpal tunnel syndrome is a condition that affects the hand, wrist and arm. Patients diagnosed with this syndrome often struggle with numbness, tingling and pain in the affected areas because of pressure on a nerve in the wrist.
Causes
Carpal tunnel syndrome is caused by pressure on the median nerve in your wrist. It is often repetitive motions that cause the syndrome, such as typing. If you suffer from conditions such as arthritis or diabetes, or if you are overweight, you may be more likely to suffer with carpal tunnel syndrome. It is three times more likely in women than men, as women usually have smaller carpal tunnels. Pregnancy is often a cause of the syndrome too, although the symptoms usually ease after giving birth. Some people may be more genetically predisposed to have the condition.
Symptoms
Common symptoms include:
- An aching pain in your fingers, hands and arms
- A tingling feeling similar to pins and needles
- Numb hands, a weak thumb and difficulty gripping
- More severe symptoms in the morning and overnight
Diagnosis
If you have any of the symptoms listed above and think you may have carpal tunnel syndrome, seek advice from a specialist.
Imaging
Often imaging is not needed but may include tests such as MRIs or ultrasounds in some situations. ’Nerve tests’ are sometimes used in which electrodes are taped to the skin to measure the nerve signals of your hands and arm.
Treatment
Conservative (Non-operative)
Before surgical treatment for carpal tunnel syndrome is considered, there are several other options which may be useful, and your surgeon will guide you with this. It depends on how far advanced the syndrome is. If you are advised to wear a wrist splint at night whilst you sleep it can take around four weeks to notice an improvement. Anti-inflammatories and a reduction in activity may help, although they don’t treat the underlying cause of carpal tunnel syndrome. A steroid injection to reduce the swelling around the nerve may be offered in some cases, which may ease the symptoms.
Surgical treatment
An operation called carpal tunnel decompression or release may be advised by your surgeon to ease the symptoms of carpal tunnel syndrome. It involves cutting the transverse carpal ligament, which is connected to the wrist bones that form the carpal tunnel. If you are undergoing carpal tunnel surgery, you will be treated as a day case patient, meaning that you will not have to stay in hospital. This may be under a local anaesthetic, with sedation or with general anaesthetic in some cases.
Carpal tunnel release surgery involves an incision being made near the bottom of your palm, and your carpal ligament being divided with a knife, which then takes the ‘pressure off’ your median nerve. The skin will then be closed with stitches, before a bandage is applied to the hand.
Recovery
The recovering from carpal tunnel release surgery is generally well tolerated. Simple pain relief with Panadol and ibuprofen may be required to help ease the pain after the local anaesthetic has worn off. It is important to elevate the hand for 48 hours after the surgery, and to open and close your fingers to make a fist. This helps reduce swelling and stiffness. A bandage will be applied, on top of an underlying waterproof dressing. These must be left in place until your first review appointment. Most patients find that they are recovered after about six weeks. If you are very active and/or do manual work it may take up to twelve weeks.
When can I return to normal activities?
- Work – this depends on your individual employment, however if your job mainly involves office/sitting then you may be able to return within a few days. If you do heavy work this will be longer and your surgeon will advise you.
- Driving – You should be able to drive once you feel confident you will be in control of the car. This means being completely comfortable with performing an emergency stop, gripping and controlling the steering wheel and sitting comfortably in your car. If you are unsure whether it is safe for you to drive, please ask your surgeon.
- Exercise – Everyday activities such as getting dressed and typing will help to regain strength in your hand. Heavier exercise, such as weight lifting or playing a sport, will be variable and you should discuss with your surgeon.