The carpal tunnel is a narrow passageway located on the palm side of the wrist. The tunnel is surrounded underneath by the bones of the wrist and across the top has transverse carpal ligament. Inside the carpal tunnel are flexor tendons as well as the median nerve.
It has an important function for movement of the hand by allowing the hand to open and close while the median nerve gives feeling to the thumb, index finger, middle finger and part of the ring finger.
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a progressive and painful condition affecting the median nerve. If the carpal tunnel narrows or if the tendons within the tunnel thicken or become aggravated, inflamed, or swollen it reduces the median nerve’s space in the tunnel. This results in the median nerve becoming squeezed causing extra pressure to be placed on the nerve. This extra pressure can lead to pain, tingling, itching and burning sensations and numbness especially in the thumb, index and middle finger, pain in the wrist or forearm and trouble in gripping objects.
What causes carpal tunnel syndrome?
Carpal tunnel is more common in women between 40 and 60 years. Conditions that cause the tendons to be aggravated or inflamed can be from an underlying medical condition resulting in swelling of the wrist or restricted blood flow such as diabetes and rheumatoid arthritis and can be common in the final months of pregnancy. It can also be caused due to a wrist fracture or congenital factors for people who have a smaller tunnel.
Carpal tunnel can commonly be a result of occupations requiring repetitive hand movements including cashiers, hairdressers and barbers, sewers, and people who use keyboards continuously along with other occupations that involve ongoing repetitive movements that bend and flex the wrist.
How can the risk of developing carpal tunnel due to occupational repetitive movements be reduced?
There is no proven way to prevent carpal tunnel syndrome, but if you are experiencing early signs and symptoms you can adopt different practices which may prevent it from further occurring. Try the following:
- Take regular breaks to rest your hands and wrists. These don’t need to be long – approx. 3 minutes every 2-3 hours is enough. While you are on our break stretch and bend the wrists and hands forwards and backwards.
- Watch the position of your hands and wrists. Try to concentrate on relaxing and reducing the force of your grip. You can try to keep your wrist straight or only slightly bent.
- Engage in hand and wrist exercises that stretch and strengthen the muscles in your wrists and hands.
- Check your posture. This is important to people working on computers. Poor posture means the shoulders droop and roll forward which can affect the position of your wrists and hands.
- Wear a wrist splint. This can be beneficial while sleeping to hold the wrist in a neutral position.
Can carpal tunnel be left untreated?
If left untreated carpal tunnel can lead to a permanent weakness and lack of coordination of the thumb and fingers.
Are there non-surgical treatment options?
First line non-surgical treatment options for carpal tunnel include:
- Lots of rest for the affected hand. This can be problematic if the cause is occupation based.
- Physiotherapy and exercise
- The wearing of splints
- Injections into the affected area to reduce swelling
What is carpal tunnel release?
If the carpal tunnel does not improve through non-surgical treatment options, a carpal tunnel release surgery can be performed.
During a carpal tunnel release, our doctor places a tight tourniquet around the upper arm. He then makes one or two incisions in the palm area over the carpal tunnel. It is important that only trained surgeons perform this procedure to ensure all care if taken to not injure the sensory nerves to the palm.
At the base of the incision there is a thick band of rope like tissue (the transverse carpal ligament) which is released allowing the contents of the carpal tunnel and in particular the median nerve to be decompressed (release of pressure). The tunnel is then checked to ensure that there an adequate release has been achieved and if necessary, a neurolysis (freeing) of the nerve is performed.
The incisions in the skin are then sutured closed and wound dressings are applied.
This is a quick, day only procedure taking around 10 minutes to perform either under a local or general anaesthetic.
What is involved with recovery and rehabilitation after a carpal tunnel release?
As this is a quick day only procedure you will be able to return home soon after the surgery. You will likely have some discomfort which can usually be managed through simple pain killers. Your hand should be kept elevated and active finger movements are encouraged.
After 48 hours your bandages will be removed but the sticky dressing covering the wound remains in place for 10-14 days after the surgery when the sutures are removed.
In most instances, patients notice an improvement in symptoms with a few days but in some cases, patients may experience ongoing symptoms for up to 3 months after the surgery.
Once the sutures are removed you are able to return to driving. You will need a minimum of 2 weeks off work after your surgery, however if your job involves heavy manual work, frequent hand washing or water immersion you may need a longer period off work. You can discuss this with our doctor prior to your surgery.
Book for a consultation
If you are experiencing symptoms of carpal tunnel, arrange for a consultation with our specialist hand surgeons. Early treatment and intervention have proven to have better outcomes with over 95% of patients being happy with the results of carpal tunnel release surgery with ongoing specific complications resulting in a failure to resolve symptoms being more common in patients who have had longstanding carpal tunnel syndrome.
Call our team today on 1300 399223 to arrange for a consultation with our specialist hand doctor at John Flynn or Pindara.