Reading
Berkshire
Harley Street
London
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Carpal Tunnel Syndrome
What?
Carpal tunnel syndrome is a condition where pressure or compression on a nerve in your wrist known as the Median nerve causes tingling, numbness and weakness in your hand and fingers.
Why?
The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of the hand. This 'tunnel' contains the median nerve which supplies the skin and muscles to the thumb, index and middle finger. Anything that causes compression or irritation of the nerve can cause symptoms. In the majority of cases the cause is unclear but narrowing of the carpal tunnel can occur after a wrist fracture, pregnancy due to increased swelling or due to inflammatory conditions.
There are are number of risk factors that have been associated with carpal tunnel syndrome but the evidence is not completely clear. Some of these include working with vibrating heavy machinery, manual work that that requires prolonged or repetitive flexing of the wrist and extensive hours of using the computer mouse.
Who?
Carpal tunnel syndrome is the most common hand complaint affecting about 5% of the population. Although Carpal tunnel syndrome can occur at any age it is more common in people aged between 40-60 years.
How?
DIAGNOSIS:
In carpal tunnel syndrome, the pain or tingling sensation is usually felt in the the palm, the thumb index and middle fingers of the hand. These symptoms often develop during sleep and are particularly noticeable upon waking. Affected individuals typically shake their hand to help get rid of the pain and numbness. In more than 50% of cases, both hands are affected.
Pain and tingling may be triggered by certain activities such as driving, typing, or holding a telephone.
Over time, persistent median nerve compression can cause muscle and nerve wasting (atrophy) in the affected hand causing numbness and weakness of the hand. Affected individuals may have difficulty performing manual tasks such as turning doorknobs, fastening buttons, or opening jars. The pain and tingling may change from intermittent to permanent. If left untreated this can result in permanent weakness and numbness of the hand.
Carpal tunnel is diagnosed by confirming your symptoms and examining your hands. Two specific tests are commonly used to reproduce your symptoms by tapping on your wrist and flexing your wrists. Examination of your neck is important as nerve roots originate therefore may also be compressed by slipped discs.. Further evaluation of the condition of the nerve is usually required using nerve conductions studies.
TREATMENT:
The first line of treatment is simple measures like adjustments to support your wrist whilst using the computer, taking breaks when using vibrating machinery or wearing a splint at night. These can purchased from a healthcare retailer or online.
The next line of treatment is a Cortisone/Steroid injection which helps to reduce the inflammation around the nerve.
If symptoms do not settle down after 6 weeks after a injection or become persistent then carpal decompression surgery to release the pressure on the nerve should be considered.
Carpal tunnel decompression is the surgical treatment to relieve the pressure on the median nerve by cutting the thickened transverse carpal tunnel ligament which, forms the roof of the carpal tunnel. This is done through a small incision on your palm under local anaesthetic whilst your awake.
Me?
TREATMENT OPTIONS:
The decision to undergo a carpal tunnel decompression is dependent on the severity and progression of your symptoms. Longstanding compression of the median nerve can result in irreversible damage leading to permanent weakness and numbness of your thumb, index and middle finger. Even after Carpal tunnel decompression surgery you may only get partial recovery in chronic cases, especially with advancing age.
Carpal tunnel compression surgery is very safe with a 97% success rate. The risk of any major complication is less than 0.5% which include infection, wound breakdown, nerve damage, tendon damage and Complex Regional Pain Syndrome (worsening of pain and stiffness).
Help?
Useful external patient info links:
How long do I keep my hand elevated after surgery?
I generally advice patients to keep the hand elevated for 12 hours after surgery.
When can I remove the bulky dressings?
The bulky dressings can be removed 48 hours after surgery. It is is important to keep the inner dressing dry and clean until the stitches are removed.
When will I Need stitched removing?
Wounds in the hand usually take 10 days to heal and therefore your stitched should be removed by the practice nurse at 10- 14 days.
When can I start using my hand after surgery?
It is important to keep the fingers moving immediately after surgery. However, be careful not to overuse the hand during the first two weeks as it may cause an increase in scarring and pain. Do not do anything that makes your hand hurt or feel stiff.
When Can I go back to work?
Return to work is dependent on your job but generally you should be back at work between two and six weeks. For this period you may need to make some adjustments to your work to avoid any activities that make your hand hurt.
After six weeks, if the hand still feels weak or stiff then we will recommend that you are referred for physiotherapy
When can I start driving?
You must not drive while your hand is in the bandage. After this you can resume driving as soon as you feel comfortable and feel safe to control a vehicle. This is generally around two weeks after surgery.
What should I be looking out for after surgery?
If your hand becomes red, hot, swollen or more painful than usual, contact us.
British Society for Surgery of the Hand Carpal tunnel syndrome Patient info leaflet
Carpal tunnel syndrome exercises