Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a common hand condition that affects people of all ages but is usually diagnosed in people over the age of 50. It is also more common in women than men.

Carpal tunnel syndrome is caused by pressure on the median nerve in the wrist and causes pain, numbness and tingling in your hands and fingers.

We rely on the median nerve for sensation in our thumbs, index and middle part of the ring finger. The nerve sits inside the carpal tunnel which is a narrow channel surrounded by ligaments and bones, located on the palm side of the hand that travels across the wrist joint and into the base of the hand. This is why people often experience symptoms at the base of the palm of their hand.

Symptoms of carpal tunnel syndrome can begin gradually and occur infrequently and are usually worse at night and can include:

An ache or pain in your fingers, hand or arm
A numb feeling in your hands
Pins and needles
Difficulty gripping objects
A weakness in the thumb

Certain factors can make you more susceptible to developing carpal tunnel syndrome. These include:

Being overweight
Having other health conditions such as diabetes or an underactive thyroid
Pregnancy
Other injury to the wrist such as a wrist fracture
Repetitive activities that put your wrist into an unnatural position
Inflammatory conditions such as rheumatoid arthritis
Tumour or growth that presses on the nerve

Carpal tunnel syndrome can sometimes get better by itself, particularly in cases when the onset is caused by pregnancy.

Diagnosis

To find out whether you have carpal tunnel syndrome your doctor will first assess your neck, shoulders, hands and wrists to establish whether there is a possible underlying condition or injury that may be causing your symptoms.

A test that doctors sometimes use to confirm carpal tunnel syndrome is a nerve conduction study. This is a diagnostic test that measures the speed of your nerve impulses. If the nerve impulses are slower as the nerve passes into the hand, you may have carpal tunnel syndrome.

Non-surgical treatments

If carpal tunnel syndrome is diagnosed early, the following treatments can be effective at easing symptoms and improving hand function:

Wearing a wrist splint at night whilst you are asleep, keeps the wrist straight and relieves pressure on the nerve. Wearing a splint for 4-6 weeks at night, can help reduce any symptoms of carpal tunnel syndrome

Reduce activities that encourage frequent bending of the wrist or the need of a strong grip

Painkillers like paracetamol and ibuprofen can help ease any carpal tunnel pain in the short term

Steroid injections into the wrist can reduce swelling around the nerve and ease symptoms. Whilst injections can be effective for many people, it can take a few weeks to feel the benefits. They can also wear off after a few months and symptoms can return. If your symptoms do return, you may be able to have another injection, but it is not always effective.

If non-surgical treatments are not successful and symptoms of carpal tunnel syndrome keep returning or are becoming more severe, it is advisable to seek specialist advice from a hand surgeon.

Surgical treatment

At North West Hand Surgeon, we will discuss treatment options available for your condition and find the right one for you.

Carpal tunnel release surgery is a day case procedure meaning that you will have the procedure and go home on the same day. The procedure is performed under local anaesthesia which means you will be awake during the surgery as your surgeon will only numb your wrist so that you do not feel any pain.

We will then make a small cut into your hand, and cut the carpal tunnel inside your wrist, so that it no longer puts pressure on the nerve.

The procedure takes approximately 30 minutes and usually has a high success rate. There is a chance that your symptoms may return after having surgery, and we will talk this through with you and help you decide whether surgery is the right choice for you.

Your recovery

Recovering from carpal tunnel surgery can differ from person to person, but usually most people return to full use of their hand, from six to 12 weeks after surgery.

The cut on your hand where the surgeon performed the operation may be sore for a couple of days afterwards but it should settle down, however, you may experience pain, swelling and stiffness up to a few weeks or months after surgery. If you feel any pain or discomfort during your recovery, you can take over the counter pain relief like paracetamol or ibuprofen to help.

You will be able to remove your bandages 3 days after having surgery, but it is important that you keep the wound clean and dry until you have had your stitches removed.

A nurse will see you in our outpatient clinic, 7-10 days after surgery to remove your stitches and check the wound is healing well. Your wound may look red and lumpy and may feel tender but this will settle down within a few months.

You can return to normal activities when you feel ready. It is a good idea to only use your hand for light tasks the first couple of days after surgery like holding a glass or book.

Some people feel able to drive a couple of days after surgery, whilst others wait 7 days before they feel they can drive.

If you are not using your hand, keep it elevated at all times and if you feel any pain during movement, stop for a while in case you have done too much too soon. You may find it difficult using your hand to grip at first and it may feel painful, but this should settle down between six and 12 weeks after surgery.

Returning to work after surgery will depend on the type of job that you have. Some people find they can return to work a week after surgery and perform light duties. If you have a job that requires manual handling or labour, it is a good idea to wait a couple of weeks before returning to work.

Your surgeon will discuss with you whether you need referring to a hand therapist to help with your recovery.

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Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Diagnosis

Non-surgical treatments

Surgical treatment

Your recovery

Whatever your hand or wrist condition is, we can help.

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