Carpal tunnel syndrome
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What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) is caused by compression of the median nerve, one of the nerves that controls feeling and movement in the hands.
The median nerve travels through the carpal tunnel, which is a narrow passage in the wrist made up of small bones and soft tissue that act as a pulley for the tendons that bend the fingers.
What are the symptoms of carpal tunnel syndrome?
CTS is a relatively common condition which can include pins and needles, a weakness in the thumb and a dull ache in the hand or arm. Discomfort can be particularly evident at night.
Little is known about what causes the compression of the median nerve but contributory factors seem to be: a family history of CTS; injury to the wrist; pregnancy; conditions such as rheumatoid arthritis and diabetes; repetitive use of the hand(s).
When is treatment for carpal tunnel syndrome necessary?
CTS can range from an inconvenience to a source of intense pain. A range of treatments are available and the treatment you may receive to deal with your CTS will depend in its severity and how long you have had it.
It is not likely to be necessary for you to have surgery immediately. Your treatment will begin with your GP, and then a referral to the musculo-skeletal physiotherapy service. Treatment may start with wrist splints to help keep your wrist in a neutral position. This prevents your wrist from bending and thus avoiding putting additional pressure on your median nerve.
An improvement in symptoms may be noticed within four weeks.
Your doctor may also suggest corticosteroid injections, especially if wrist splints have not worked for you. Steroids are natural hormones produced in the body that can help reduce inflammation. Corticosteroids can be taken in tablet form, although for CTS they are usually injected straight into the wrist. One injection is given to see if this is the right therapy for you. If one injection has proved effective but the condition returns (which it sometimes does) this form of treatment may be repeated after a period of time.
What is carpal tunnel syndrome surgery?
If your CTS has not responded to wrist splints or corticosteroid injections the next step may be surgery. You should discuss this with your GP and your surgeon to make sure that all other forms of treatment have been exhausted and that you are made fully-aware of the implications of surgery.
This type of surgery is known as carpal tunnel decompression or carpal tunnel release. It is carried out as day surgery under local anaesthetic, which means you do not need to stay in hospital overnight.
The carpal ligament, which is the roof of the carpal tunnel, is cut to remove pressure on the median nerve in the wrist. In most cases this type of surgery provides a complete cure.
How long does carpal tunnel surgery take?
Carpal tunnel surgery lasts about 10 to 20 minutes and you do not need to stay in hospital overnight.
What happens after carpal tunnel syndrome surgery?
After surgery your hand and wrist will be bandaged for 24-48 hours and you should keep both elevated to reduce swelling. You will usually be asked to wear a shoulder sling and it is advisable to keep moving to help with swelling and stiffness, such as gently moving your fingers, elbow and shoulder. This can begin on the day of your operation.
You can start to use your hand and wrist for light duties provided there is no pain or discomfort. It is recommended that you avoid using your hand and wrist for any strenuous or heavy activities for at least six weeks after surgery, until you have completely recovered.
What are the risks and complications of carpal tunnel syndrome surgery?
Potential risks are those related to all types of surgery including infection, nerve and blood vessel injury. Risks related to the procedure include a dull pain around the surgical scar called ‘pillar pain” which usually resolves itself within months.
A pre-operative assessment is our opportunity to ensure that the procedure for which you have been referred is right for you. We’ll explain your treatment to you and makes sure that you are well enough to go ahead with it. It is also your opportunity to meet the team who will care for you and to ask any questions.
Carpal tunnel syndrome surgery is available at the following hospitals and surgical centres:
“Not only was it considerably cheaper than traditional private hospitals, the CQC rating gave me the reassurance that I could expect high standards of care”.John Beaumont