Carpal Tunnel Syndrome

What is carpal tunnel syndrome?
Three main nerves supply your hand. One of these is called the median nerve. It runs into the palm through a tunnel, called the carpal tunnel. As the walls of the tunnel are rigid, any increase in pressure in the tunnel means that the nerve is squashed, giving rise to the symptoms of which you complain. If left untreated this can in some cases cause permanent damage to the nerve.

Carpal tunnel syndrome may arise during pregnancy, in which case it may settle when the baby is born.  It may also be related to conditions such as hypothyroidism (low levels of thyroid hormone), diabetes or kidney disease.

What treatment is available?
In mild cases no treatment may be necessary. If the symptoms are troublesome at night a splint may help.

Often however patients are keen to have something more done.  If so, the carpal tunnel may be released.  This operation is called a carpal tunnel release, or carpal tunnel decompression.  This may be performed under local or general anaesthetic.

What will the surgery aim to do?
The operation is designed to release the nerve. Three of the walls of the tunnel are bony, but the roof is formed by a thick ligament, which can be cut to release the nerve. This often gives quite rapid relief of symptoms.

What kind of scar will I have?
All surgeons make a slightly different incision. They are all in the heel of the hand and are usually about two inches long. You will have stitches in the wound and a bulky dressing. The stitches will be removed 10 to 14 days after the operation.

Endoscopic carpal tunnel release
Endoscopic (keyhole) carpal tunnel release is performed through a short incision in the forearm.  Although there is evidence that return to work is quicker with endoscopic surgery, the benefit is relatively short lived, and the long term results are similar with the two techniques,

What should I do if I have pain after the operation?
We recommend that you routinely take painkillers for 48 hours after the operation. After this, take painkillers as required. If at this stage you have increasing pain you should seek medical advice.

Do I need to do anything else?
You should move your fingers as soon as possible. When the stitches are removed, massage the wound with cream (E45, Neutrogena, Atrixo). Keep the wound dry.

How long will I be off work?
Desk job: Two days if simply supervising; otherwise two weeks
Light manual: Two weeks
Heavy manual: Four to six weeks
Driving: One week

What complications can occur?
All operations have a small risk of infection – perhaps 1%
Most patients have pain in the wound. This usually settles after three months. You may require some physiotherapy to help. In some instances the pain may last longer, but it almost always settles eventually.
There is a small risk of nerve injury – less than 1%
There is a small risk of an abnormal and prolonged pain response – less than 1%
Your nerve may not recover fully and you may be left with some symptoms.

Is there any alternative to surgery?
There is some evidence that steroid injections can be of benefit. Our current understanding o f the literature is that the symptoms frequently recur after steroid injections. Your surgeon will be able to give more advice. In cases arising because of pregnancy or an underactive thyroid, splints may help until the underlying condition can be corrected