Carpal Tunnel

The carpal tunnel is a narrow passageway on the palm side of your wrist. Small wrist bones known as carpals form the bottom and sides of your carpal tunnel and a strong band of connective tissue, known as the transverse carpal ligament, covers the top of the carpal tunnel.

The carpal tunnel houses the flexor tendons that allow you to bend your fingers, and the median nerve that provides sensation to most of your fingers and hand.

Special tissues known as synovium surround and lubricate the flexor tendons in your wrist, allowing smooth movement of the fingers. Carpal Tunnel Syndrome occurs when the synovium swells narrowing the limited space within the tunnel and pinches the median nerve over time. The transverse carpal ligament can also become tight narrowing the carpal tunnel space and putting pressure on the median nerve.

Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a painful, progressive condition that is caused by compression of the median nerve at the wrist area.

Numbness and tingling in the thumb, index, and middle fingers
Pain and burning in the hand and wrist that may radiate up the arm to the elbow
Decreased sensation and weakness in the hand with diminished grip strength
Worsening of symptoms at night or when the hands are elevated for prolonged periods

Causes

The following factors have been known to increase a person’s risk of developing carpal tunnel syndrome but most people have none of these precipitating causes.

Repetitive Motion: performing heavy, repetitive hand and wrist movements with prolonged gripping at work or play
Congenital: Some people are born with narrower carpal tunnel canals.
Trauma: Injury to the wrist such as fractures or sprains.
Hormonal Changes: Pregnancy, menopause, birth control pills or hormone pills are risk factors as they alter the levels of hormone in the body.
Medical Conditions: Conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumour extending to the carpal tunnel

Diagnosis

Your doctor diagnoses carpal tunnel syndrome by:

A detailed medical history and physical examination.
An X-ray may be ordered to view your wrist bones.
Blood tests to rule out underlying medical conditions such as diabetes, arthritis and thyroid problems.
Electro-diagnostic tests to assess the speed and degree of electrical activity in your nerves and muscles.

Treatment

Carpal tunnel syndrome can be treated with conservative measures or surgical intervention.

Conservative Treatment Options

These may include:

Conservative treatment options may include treating any underlying medical conditions, such as diabetes and arthritis.
Your hand and wrist may be immobilised with a splint or wrist brace for 4 to 6 weeks.
Ice packs may be recommended to keep down any swelling.
You may be advised to avoid activities that tend to bring on the symptoms.
Medication and steroid injections may be used to treat pain and swelling.
You may be referred to therapy to be taught strengthening and stretching exercises.

When conservative treatment options are not effective, surgery may be recommended.

Carpal Tunnel Release

During carpal tunnel release the transverse carpal ligament is cut, which releases pressure on the median nerve. Median nerve compression is the reason you experience pain, tingling and numbness therefore the symptoms are relieved. An incision is made at the base of the palm of the hand. This allows your doctor to see the structures and identify the transverse carpal ligament. After cutting the ligament, the skin is closed with stitches. The gap where the ligament was cut is left alone and eventually will be filled with scar tissue.

This procedure is usually done as a hospital day case under sedation and local anaesthetic or a general anaesthetic.

Post-operative Care

After surgery the hand is heavily bandaged and needs particular care-

Elevate the hand above heart level to reduce swelling for the first 3 days
The surgical incision must be kept clean and dry. When showering or bathing a plastic bag must cover the bandage completely.
The dressing will remain intact until review by your surgeon 7 -10 days after surgery.
Physical therapy may be ordered to restore wrist strength.

You may use your hand after the first two weeks as guided by comfort.

If you have surgery on your non-dominant hand and do not do repetitive, high-risk activities at work, you may return to work within 1 to 2 days, although 7 to 14 days is more common.
If you have surgery on your dominant hand and do repetitive or heavy activities at work, you may require a more prolonged period for a full recovery before returning to your previous work duties.

Complications

The majority of patients do not suffer any complications following carpal tunnel release surgery but as with any surgery, complications can occur and include;