Carpal Tunnel Syndrome

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This is a common condition characterised by numbness and tingling affecting either or both hands. Patients will often lose sleep due to nocturnal paraesthesia (pins and needles) and pain. The symptoms may be aggravated by driving or holding a telephone; dexterity maybe affected and the hand may feel weak and wasting may be present. The symptoms arise due to compression of the median nerve in the wrist (it is bounded by bones and a tough, unyielding ligament called the transverse carpal ligament – see diagram).

 

The cause is usually unknown though certain patients are particular vulnerable – pregnant ladies, diabetics, patients with thyroid problems, and there may be an association with patients who work with heavy power tools like pneumatic drills.

The diagnosis is confirmed clinically by examining the patient and then neurophysiologically by nerve conduction studies.

 

Treatment depends on the severity of symptoms:
Mild: splints / possibly steroid injections (temporizing only usually)
Moderate: surgery- carpal tunnel decompression
Severe: surgery

 

Surgery involves a day surgical procedure under local anaesthetic. An incision is made in the palm and the underlying ligament which forms the roof of the carpal tunnel is decompressed. Surgery, in expert hands, is usually very successful in relieving most if not all of the numbness and tingling.  As with any operation, there are risks attached (scars can be tender for a few weeks, small incidence of neurological injury, persistent symptoms especially if severe, stiffness/swelling – your surgeon will fully discuss these with you). Most patients are back at work around 2 weeks and able to drive between 2-3 weeks but this should be discussed with your surgeon.