Carpal Tunnel Syndrome

Why does it occur?

There is no definite cause for most cases of carpal tunnel syndrome. This is called idiopathic carpal tunnel syndrome. There are associated conditions and exacerbating factors. These include previous wrist injuries, rheumatoid arthritis, thyroid disease and pregnancy (when symptoms sometimes resolve after the birth of the child).

The symptoms are caused by compression of the median nerve within the bony carpal tunnel of the wrist.

What are the symptoms?

Everyone experiences slightly different symptoms depending upon the severity of the compression on the nerve. Below are the most common problems;

  • Sleep disturbance due to 'pins and needles' or a continual ache in the hand - palm, thumb, index, middle, and ring finger.
  • Similar discomfort during the day when performing some tasks.
  • Weakness or clumsiness in the hand which can lead to difficulties in picking up small items or gripping with confidence.
  • Relief of symptoms by shaking the hands or changing their position.

Investigations

A clear history of symptoms is usually sufficient to make a diagnosis. If further confirmation of the diagnosis is required, or there are other associated factors (diabetes, thyroid disease), nerve conduction studies may be performed.

Occasionally x-rays are taken to exclude osteoarthritis as a cause of some of the pain symptoms.

Treatment options

  • Non-operative treatment

Watch and wait - the symptoms may settle if they have been experienced for only a short period of time.

Splinting - holding the wrist in a neutral position using a removable splint can reduce the pressure on the nerve and relieve symptoms. This can be particularly beneficial at night.

Steroid Injection - into the carpal tunnel can temporarily relieve the discomfort of carpal tunnel syndrome.

  • Operative treatment

Carpal tunnel decompression - this is a short day-case procedure which is performed after a local anaesthetic injection (you are awake and talking to the surgeon and theatre staff).

The area will become numb although you will be aware of pressure. The tissue trapping the nerve is released and the extent of the release is reviewed under direct vision. Stitches will be placed in the skin. Dressings are applied to protect the area.

Complications

Infection - this in not common, less than 1%.

Scar tenderness - the skin heals very quickly but the tissues underneath may take longer to settle. As a result of this the area may remain tender when pressure is applied for several months.

Chronic Regional Pain Syndrome Type I -  (incidence of 1 %) this condition can occur after injury or surgery and would mean more pain and stiffness which would require analgesia and hand therapy.

Incomplete recovery- If the nerve has been compressed severely or for a long period of time recovery of nerve function may be incomplete.

Rehabilitation after surgery

Mild analgesia may be required once the local anaesthetic effect has passed. After 24 hours the bulky dressings can be removed. A small dressing must stay in place to cover the stitches and the healing skin. This area should be kept clean and dry.

Stitches can be removed after 7-10 days.

Frequently asked questions

Recurrence or incomplete relief of symptoms? - this will depend upon the individual and the extent to which damage occurred to the median nerve prior to surgery.

Restrictions in activity? - there are no specific restrictions but the area needs to be kept clean and dry while the stitches are present. Some people find that the presence of a splint can be helpful while the area is healing, once the bulky dressings have been removed.

When can I drive a car?  Most people return to drive when the sutures are removed. You should make sure your hand has recovered enough to allow you to drive safely.