Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a very common condition involving compression of the median nerve as it passes through the carpal tunnelin the wrist. The tunnel has a roof that is made up of the transverse carpal ligament and a base that consists of an arch of carpal bones. It’s not just the nerve that passes through the carpal tunnel, nine tendons to the fingers and thumb also go through it.

Carpal tunnel syndrome occurs in people of all ages but is most common in women over 40 years of age. Other conditions associated with carpal tunnel syndrome are pregnancy, thyroid disease, rheumatoid arthritis and wrist injuries.

What are the symptoms of carpal tunnel syndrome?

The main symptom of carpal tunnel syndrome isa pins-and-needles sensation, which occurs in the thumb, index finger and middle finger. This may wake you up at night and you might need to shake your hand to relieve the feeling. Pins and needles can also occur at any time during the day, particularly after periods of heavy work.

In some severe cases, the small muscles to the thumb can become weak, which causes a reduction in grip strength. The numbness of the thumb and fingers may also cause you to drop things.

What does your doctor look for?

Your doctor will take your medical history and perform a physical examination. Your doctor will check for a reduction in the sensation over the thumb, index finger and middle finger of your affected hand.

Some specific tests may be performed including:

  • Tinel’s test – where the nerves in the carpal tunnel are tapped to see if it causes tingling in your fingers
  • a modified Phalen’s test or modified Durkan’s compression test – where direct pressure is applied over the carpal tunnel by bending the wrist forward to see if this reproducespins and needles in the thumb, index finger and middle finger

What investigations are needed?

Your doctor will commonly perform a nerve conduction study, which records the speed of the conduction through the nerve at the level of the wrist. This test takes about 20 minutes to complete and is slightly uncomfortable.

How is a carpal tunnel syndrome treated?

Treatments include:

  • non-drug therapy (eg physiotherapy, wrist splints worn at night)
  • medications (eg steroid injections into the carpal tunnel)
  • surgery

Our specialists at Orthopaedic Clinics Gold Coast will work with you to create the best treatment plan for your particular situation.

Carpal tunnel surgery

Most patients with troublesome carpal tunnel symptoms need surgical treatment. The surgery is usually performed under either a local or general anaesthetic as a day procedure. It takes around 10 minutes to perform.

A tight tourniquet is placed around the upper arm to ensure a bloodless field. One or two incision are made in the palm over the carpal tunnel. Care is taken not to injure the sensory nerves to the palm. At the base of the incision, a thick band of tissue called the transverse carpal ligament is released, which allows the contents of the carpal tunnel (and most importantly the median nerve) to be decompressed. The contents of the carpal tunnel are then inspected to ensure adequate release and a neurolysis (or freeing) of the nerve is performed if required. The skin is sutured closed and dressings are applied.

Post-op rehabilitation

You will be able to go home soon after the surgery. The anaesthetic will wear off after approximately 6-8 hours and your discomfort can usually be controlled with simple pain killers. You should keep your hand elevated but there are no limitations on finger movements and are in fact actively encouraged.

The bandage dressings are usually removed after 48 hours. The sticky dressing over the wound is left onuntil the sutures are ready to be removed, which is usually 10-14 days after surgery. You need to keep the wound dry until the sutures are removed

Most patients notice an improvement in their symptoms within the first few days but some patients have ongoing symptoms for up to 3 months following surgery. You can return to driving once the sutures have been removed. But you will need at least 2 weeks off work if your job involves heavy manual work or frequent hand-washing. Some patients may require a longer period off work and this should be discussed with your surgeon prior to the procedure.

Possible complications

More than 95% of patients are happy with the results of the surgery, however complications do occur sometimes. Some complications that are specifically related to hand surgery include:infection (less than 1% chance); neuroma (less than 1% chance), which is a damaged nerve that becomes painful on reattempts to regenerate; numbness; chronic regional pain syndrome or reflex sympathetic dystrophy (1–2% chance), which is a reaction to surgery that can cause painful or stiff hands.

Specific complications related to carpal tunnel syndrome include failure to completely resolve the symptoms (less than 5% chance). This is more frequent in patients who have had longstanding carpal tunnel syndrome with severe damage to the nerves or wrist pain.