Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a condition characterized by the compression of the median nerve as it passes through a narrow tunnel at the wrist. The tunnel contains both the tendons responsible for finger and thumb movement and the median nerve. The median nerve is one of the main nerves supplying movement and feeling to the hand and compression of this nerve in the tight tunnel is what causes symptoms.
The primary symptom of CTS is altered sensation in the hand, typically affecting the thumb, index, middle, and ring fingers, with the little finger usually remaining unaffected. Many individuals describe this altered sensation as tingling, which often worsens at night or upon waking in the morning. Certain activities that involve gripping objects, such as holding a mobile phone or newspaper, may bring on or worsen tingling, especially when the hand is elevated. Initially, tingling may be intermittent, with sensation returning to normal between episodes. However, as the condition progresses, altered sensation may become continuous, accompanied by numbness in the fingers and thumb, weakness, and muscle wasting at the base of the thumb. Patients may also experience a sense of clumsiness and have difficulty holding onto objects. Pain in the wrist and forearm may also be present in some cases.
While CTS predominantly affects middle-aged women, it can occur in individuals of any age or gender. Certain factors like pregnancy, diabetes, thyroid disorders, rheumatoid arthritis, and other conditions may contribute to CTS, although many sufferers have no underlying health issues. Inflammation of tendons, wrist fractures, arthritis, and other less common conditions can also lead to swelling within the tunnel, exacerbating CTS symptoms. The exact cause, however, is often unknown.
Non-surgical treatments for CTS can include hand therapy and the use of splints, particularly at night. Steroid injections into the carpal tunnel can give good relief, and if there is a transitory cause this relief may be permanent. CTS occurring during pregnancy often resolves after childbirth.
However, surgery is frequently required for persistent or severe cases. The surgical procedure involves opening the roof of the carpal tunnel to alleviate pressure on the median nerve. This is typically achieved through an incision over the tunnel at the wrist, allowing direct visualization for roof opening. Surgery may be performed under local anaesthesia, regional anaesthesia (administered at the shoulder to numb the entire arm), or general anaesthesia, depending on technical factors and patient preference.
Carpal tunnel release surgery is a well known operation, with good results and a low complication rate. However, there are other conditions that may mimic carpal tunnel syndrome, and these will not respond to carpal tunnel release. Therefore, an accurate diagnosis is critical.
Carpal tunnel surgery is generally safe. However, like all surgery, there are potential risks of complication. Generic risks include pain, bleeding, infection or wound healing problems. Injury to the main trunk of the median nerve is extremely rare. However, branches of the nerve which give feeling to the lower palm, or movement to the thumb muscles, can occur even in the hands of an experienced surgeon. Most patients take about 3 weeks to return to normal activities, but some pain conditions can last longer. Finally, it is generally recommended not to operate on two hands at once, as having reduced function in both hands at the same time can make for a challenging recovery.
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Disclaimer: This website is intended to provide you with general information only. This information is not a substitute for advice from your Specialist Plastic Surgeon and does not contain all the known facts about this procedure or every possible side effect of surgery. It is important that you speak to your surgeon before deciding to undergo surgery. If you are not sure about the benefits, risks and limitations of treatment, or anything else relating to your procedure, ask your surgeon to explain. Patient information provided as part of this website is evidence-based, and sourced from a range of reputable information providers including the American Society of Plastic Surgeons, Better Health Channel and Mi-tec medical publishing.
