Carpal Tunnel Syndrome

This is a common condition that causes intermittent numbness and tingling of the thumb, index, middle and part of the ring finger and on occasions involves all fingers.  It can wake the patient at night and may come on after driving or telephone calls with that hand. One or both hands may be affected.  It is caused by the compression of the median nerve at the wrist, and if left untreated may cause permanent numbness and in more severe cases  thumb weakness.

Causes carpal tunnel syndrome

In most cases there is no obvious cause, but it may be due to Diabetes or Rheumatoid Arthritis, a poorly functioning thyroid or arthritis of the neck. Rarely, a previous fracture of the wrist may lead to carpal tunnel syndrome.

Treatment options 

A steroid injection and a wrist splint (particularly at night) help the majority of patients who are usually symptom free for 6 months or more.  Repeat injections can be done at this stage and surgery is also an option.

Surgery

This is day case procedure taking about 30 minutes.  Local anaesthetic is injected into the wrist and an incision about 2 cms long made, allows release of the tight ligament compressing the median nerve. The wound will stitched and dressings applied which should be kept dry.

Complications 

Surgery for carpal tunnel release is safe and results predictable. But the risks include infection, bleeding and wound breakdown. It is also includes wound tenderness, recurrence of symptoms and and very very rarely, injury to the nerve itself. The hand can also be stiff after surgery and may require hand therapy. 

Recovery time 

A bandage allows moderate hand use afterwards and a wound check is arranged at one week with follow up in my clinic at 2 weeks, when the stitches will also be removed.  If there has been permanent numbness of the fingers before surgery, sensory recovery of the fingers is unlikely to return to normal even in the longterm.