Mr Apurv Sinha
Consultant Trauma and orthopaedics
Video explaining carpal tunnel syndrome
Surgical video: carpal tunnel release performed by Mr Apurv Sinha
Watch here: https://youtu.be/bLYLVNjP7H8
CARPAL TUNNEL SYNDROME
What is the Carpal Tunnel?
The carpal tunnel is a small tunnel made of the ‘transverse carpal ligament’ and the wrist bones which houses several tendons and a nerve (the median nerve) which control sensation and movement in the hand.
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is a common condition due to a build-up of swelling and pressure inside the tunnel, reducing the space that the tendons and the nerve have and can compress the nerve.
This compression of the Median nerve causes pain, numbness and burning/tingling sensation in the hand and fingers.
Why does it occur?
The exact cause of Carpal Tunnel Syndrome isn’t always known but certain things can be linked to a high incidence of the condition:
Family history: some research shows a genetic link to carpal tunnel syndrome
Certain health conditions: for example diabetes, rheumatoid arthritis, gout, hypothyroidism, obesity, oedema/ swelling
Pregnancy: due to fluid retention (swelling)
Certain injuries: to the hand or wrist such as sprains, ligament injuries or fractures can cause swelling in the wrist which may put pressure on the nerve
Certain activities which involve lots of repetitive wrist movement forwards and backwards
What are the symptoms?
Tingling or numbness in the thumb, index, middle and half of the ring fingers.
Other symptoms include:
aching/ discomfort in the hand forearm.
Burning/ prickling sensation
Changes in the colour of the skin
Weakness in the muscles of the thumb
Wasting of the muscles of the thumb
What tests might be done?
Carpal tunnel syndrome can be diagnosed clinically by carrying out a few simple tests and by asking you about symptoms.
On occasions ‘Nerve Conduction Studies’ may be carried out to confirm the diagnosis or check that there isn’t a problem elsewhere.
Nerve conduction Studies
In Nerve Conduction Studies a small electrical current is sent through the nerve via small electrodes placed on the arm and fingers. The time taken for the current to travel and its amplitude is measured. This will help to identify where the nerve problem is and how severe it is.
What is the treatment?
Carpal Tunnel Syndrome can be managed non-operatively but in some cases, surgery may be required.
Splinting: Splints can be purchased or provided by a therapist which rest your wrist in a straight/ neutral position in which the carpal tunnel is at its widest and preventing it from bending and applying further pressure on the nerve.
Advice/ lifestyle changes: Sometimes being given advice on carpal tunnel syndrome and the types of activities to avoid can help reduce symptoms and allow the inflammation to settle down.
Steroid Injections: These can be injected into your wrist to help relieve the swelling and pressure around the nerve.
Operative Treatment: Carpal Tunnel Decompression:
Surgery is usually recommended for
Severe symptoms that have lasted for six months or more.
Persistent numbness in fingers
Weakness in hand/wasting of thumb muscles
Inability to carry out routine daily activities or work.
What to expect after the operation?
This surgery is normally performed as a day case under a general anaesthetic or regional block.
During the operation, the surgeon makes an incision in the wrist and cuts the ligament that forms the roof of the tunnel which helps to relieve the pressure on the nerve.
After the operation, it is recommended that you ensure you maintain movement in your wrist and fingers gently to prevent them from stiffening up.
If after your surgery you have any problems with weakness or sensitive scarring you may need to see a therapist. Your surgeon will advise you on this.
What are the risks of carpal tunnel release surgery?
Things to consider before having a carpal tunnel release:
There is a small risk of infection
In some cases, the operation may not work/ may need repeating
In some cases where the nerve has been severely damaged, there may be permanent and irreversible changes in the hand including tingling/ numbness and or loss of strength/ control
Risk of problematic scar tissue. After the operation, there is a risk that you may have problems with scarring including tender/ sensitive scarring. Thick/ hard scarring causing reduced movement
Risk of some stiffness of the wrist and fingers following the operation
Risk of Reflex Sympathetic Disorder (RSD). Can also be known as Chronic Regional Pain Syndrome (a malfunction of the nervous system that controls your pain)