Carpal Tunnel Syndrome
What is happening to cause my carpal tunnel syndrome (CTS)?
The median nerve, a large nerve supplying some of your hand’s function, enters the hand from your forearm by passing through a tunnel bound on the back of your wrist by several bones, and on the palm side of your wrist by a thick ligament called the transverse carpal ligament. This tunnel is called the Carpal Tunnel. If the nerve becomes compressed within the tunnel, it fails to function normally and the symptoms of CTS result. It is possible for conditions which cause swelling of the body, or for lumps such as a ganglion (fluid filled cysts) to result in compression of the median nerve, but the usual cause for CTS is called “idiopathic carpal tunnel syndrome” the cause of which is not fully understood.
Who gets carpal tunnel syndrome?
CTS is a common hand disorder; approximately 1 in 10 people in Australia have surgery for this condition during their lifetime. It is especially common in late pregnancy, following childbirth, and is more common in individuals with medical conditions including diabetes or thyroid disease.
What are the symptoms of carpal tunnel syndrome?
You would usually experience pins and needles and numbness in the thumb, index, middle, ring and often the little finger, in addition to pain in the wrist sometimes going up into the forearm. If you have numbness in the little finger, this is due to compression of a different nerve called the ulnar nerve, often at the wrist or the elbow. CTS can develop over a short period, or often over a period of some months or years. The affected hand may feel weaker than normal and clumsy. Sufferers often drop items or find it difficult to manipulate small items. The symptoms can cause insomnia and can be quite debilitating if severe. CTS can occur in both hands at the same time.
How is CTS diagnosed?
A Specialist Orthopaedic Surgeon such as Mr Jarrett should assess you and your hand to confirm the diagnosis, ensure there are no additional conditions present to cause the symptoms and to investigate any particular causes for the CTS. Sometimes an additional nerve test called Nerve Conduction, or EMG Studies can be useful to confirm the diagnosis and ascertain how poorly the nerve is working. Your doctor may also arrange an ultrasound to help establish whether you have carpal tunnel syndrome. Nerve conduction studies are carried out by a Neurologist who passes small electric currents within your arm and hands to measure the way that the electrical signals travel along the nerves. It is not necessary for every patient with CTS to have nerve conduction studies before having treatment.
How is carpal tunnel syndrome treated?
Non Operative Treatment
Early management may consist of changing your activities and using a splint at night to rest your wrist. Should this be ineffective, a short course of non-steroidal anti-inflammatory medications such as Ibuprofen, and hand therapy may improve the situation. Steroid injections into the carpal tunnel may be used in some cases to good effect, although this is often temporary. Some patient’s symptoms settle with the above therapies.
Should non operative treatment be unsuccessful, an operation called a Carpal Tunnel Decompression (CTD) is usually recommended. CTD is by far the most reliable treatment for CTS.
Carpal Tunnel Decompression involves the release of the transverse carpal ligament on the palm side of the wrist, thereby taking pressure off the median nerve. The day surgery procedure is carried out through a small wound on the palm, usually under local or general anaesthetic. If the CTS affects both hands, it may be reasonable, for some patients, to perform CTD operations on both hands during the same sitting. This operation is very effective in markedly improving most sufferer’s symptoms and should provide some relief in nearly all patients. If the CTS has been long-standing before the operation, the nerve may take some time to recover following CTD. If longstanding CTS has scarred the nerve, it is possible that recovery may be limited.
Endoscopic Carpal Tunnel Decompression
An alternative to making a small wound in the palm is to make a small wound at the wrist and undertake the operation using an endoscope (telescope). The endoscopic carpal tunnel decompression has a slightly quicker recovery, but statistically, has slightly higher risks.
Mr Jarrett commonly performs the operation through the small wound in the palm, but can undertake the procedure endoscopically if you would prefer this.
Carpal Tunnel Decompression Postoperative Care and Recovery
Upon completion of your CTD, a small bandage is placed around your wrist, and a sling is used to elevate your hand for at least 3 days. Your fingers are capable of movement immediately following the procedure, but the use of your hand will be restricted by discomfort for a few days. The hand bandage can be removed in two days, leaving the small dressing in place for a further week. The sutures are absorbable, so no suture removal is required. You can start washing your wound from 10 days after the operation, and the sutures will fall out over 2 to 3 days (a video on my website goes into wound care).
Depending on the nature of your job, it is usual to return to work after 2 to 4 weeks and start driving between 1 to 2 weeks. The wound may remain tender for some weeks or occasionally months, settling gradually over time. Complications of CTD are infrequent but can include wound infection (1%), bruising, stiffness, recurrence of CTS and rarely nerve injury causing pain, numbness and weakness, sometimes permanently. The condition known as Trigger Finger is commonly associated with carpal tunnel syndrome. A portion of people with carpal tunnel syndrome will develop Trigger Finger regardless of having carpal tunnel surgery, but those people who have carpal tunnel surgery are slightly more likely to develop a trigger finger(s) in the future compared to those who have not had carpal tunnel surgery. Furthermore, patients who have trigger digits and have had a carpal tunnel operation in the past do not usually respond to steroid injections for their trigger digits.
You are welcome to watch our postoperative wound care video for furthur information about managing your dressing and wound on https://goo.gl/AqrB8z or use the QR code below.