Carpal tunnel syndrome is a very common condition. As many as one in six women will experience carpal tunnel symptoms at some stage in their life.
There are multiple reasons why people develop carpal tunnel syndrome and there are many conditions associated with it. For example, it is more commonly seen in patients who are diabetic or who have thyroid disease. There is an association with smoking, and patients with obesity are more frequently affected.
In many cases however, no clear cause can be identified with the onset of the condition and it may occur without any associated medical issues.
Most patients present with intermittent pins and needles in their hands. The median nerve supplies sensation to the thumb, index, middle and ring fingers. If the nerve becomes compressed, patients may experience episodes of sensory changes in this region.
Some patients will present with a generalised aching sensation in the hand. In more severe cases, patients may progress to have complete numbness in the hand.
Classically, patients are woken from sleep at night with sensory changes in their hand and they have to move the fingers to get the sensation to return to normal.
Treatment options for carpal tunnel syndrome can include simple measures such as wearing night splints to help hold the wrists in an extended position. Many patients with carpal tunnel syndrome tend to sleep with their wrists in a flexed position and this can provoke the symptoms. Simply sleeping with the wrist in an extended position may help relieve the symptoms.
In some cases, a steroid injection may be considered to try to help settle the symptoms. This is designed to reduce the volume of the inflamed tissue travelling through the carpal tunnel which puts pressure on the nerve.
When patients have reached the point where they are not settling with simple treatment measures, we often proceed to a surgical release of the carpal tunnel. The carpal tunnel is a short pathway in the front of the wrist that the flexor tendons and the median nerve travel through.
In carpal tunnel decompression surgery, the ligament overlying the top of the tunnel is released. This decompresses the nerve.
In most cases, patients will experience a rapid improvement in their pins and needles and sensory changes.
On some occasions, patients present with severe symptoms that may have been present for a long time. In cases where patients have progressed to having complete numbness within the hand, there may be more significant damage to the nerve. In these instances, recovery may not be as quick or as complete.
The surgery is performed as a simple day case. Some patients may like to have the procedure performed under local anaesthetic and sedation. A tourniquet is used to prevent any bleeding. Sutures remain in place for the first two weeks.
Patients are reviewed at the two-week stage for removal of sutures. Most people are able to start doing lightweight activities at that stage. Heavy loading and gripping tasks are still avoided for a further month.
Risks of surgery
As with all operations, there are some surgical risks. There is a small risk of infection with the procedure. Patients may also experience some generalised tenderness around the surgical area on the front of the wrist.
On occasions patients may get some aching which persists around the base of the thumb. This usually resolves over time – but in some instances, it can linger for a few weeks or months. Patients may experience some bruising and swelling around the forearm.