Carpal Tunnel Syndrome (CTS) is a relatively common condition caused by excessive pressure being exerted on the nerve in the wrist. Carpal = Wrist.
The Carpal bones are positioned in a semi-circle and form the floor of the tunnel.
The roof of the tunnel is made of tough carpal ligament. Running through the tunnel is the median nerve (which controls feeling and movement in the hands) and tendons.
CTS is caused when tissues around the tunnel swells causing compression of the median nerve. This compression causes the symptoms of aching, numbness, tingling in the fingers, thumb and part of the hand. The Swelling may be due to pregnancy, an under active thyroid gland or more commonly ‘wear and tear’ changes in the carpal bones and thickening of the tendons
What are the treatment options?
- Conservative Treatments
Simple stretching exercises, hanging your arm out of bed at night, resting the wrist and applying cold packs can all relieve mild symptoms. Wrist splints worn at night can also help in mild cases. These keep the wrist straight preventing pressure being exerted on the nerve. Most cases associated with pregnancy will resolve after delivery. Hypothyroidism should be treated with thyroxine.
An injection of steroid or local anaesthetic directly into the wrist is another treatment option in mild cases. It is 60% effective but only provides relief for a short time in most cases.
- Surgical Treatment
For moderate and severe cases the only effective long-term treatment is surgical decompression. This involves cutting the carpal ligament to make more room for the nerve and tendons. This will leave you with a small scar at the base of your palm.
Unless there are other medical reasons, this will be done as a day case under local anaesthetic and you can go home the same day. You will be asked to come in an hour or so before the operation. You may have a light meal before you come in.
Please inform us if you are taking Warfarin, Clopidogrel, Apixaban or Aspirin as soon as possible. You may need to stop these several days before surgery. Your surgeon will advise.
You should continue to take all other medication. The Surgeon will see you immediately before the operation. He or she will discuss the operation with you and ask you to sign a consent form.
After the operation you will need to stay for approximately 1 hour to make sure the wound is fine and there are no immediate complications. You cannot drive immediately after the operation and it is best if someone can pick you up from hospital.
Risks of Surgery:
The main risk is of infection in the hand. The risk is 2%. This could be a simple superficial skin infection or a more serious deep palmar space infection.
There is a risk of nerve damage (<1%). This could cause paralysis of the thumb, index or middle fingers and numbness.
The wound will be tender for an average of 6 weeks after surgery. You will be able to move your fingers and do light tasks but heavy lifting may be a problem.
Post operative advice:
Keep your arm elevated and fingers moving. Keep the bandage on for 48 hours and keep the wound clean and dry. (You will be given spare dressings to go home with).
After the bandage is removed you may shower but do not soak the hand. Try to keep it as dry as possible but if it does get wet dab it dry with a clean towel or tissue and replace the dressing. Do not soak it in the bath while the stitches are in.
Your stitches should be removed 7 -10 days after your operation. This will be done at your local surgery or at the Murrayfield Hospital. Painkillers such as Paracetamol or Ibuprofen are usually strong enough for pain relief. You should avoid strenuous work for 6 weeks as your hand will be tender. You are advised to move the fingers through their full range of movement several times a day to stop the scar tissue from tethering the tendon sheaths.
You will be seen in the clinic for a Follow up appointment around 4 weeks to check your progress.
The surgery is usually very effective at getting rid of the symptoms. In a few cases the nerve is too badly damaged by the compression to fully recover and some of the symptoms may not improve.