Carpal Tunnel Syndrome – CTS- is a common condition that affects a large number of the population.
Patients generally report a gradual onset of symptoms in the hand and wrist. There is not a single event that causes CTS, but people who suffer from rheumatoid arthritis, diabetes, thyroid disorders, perform repetitive wrist work and who are overweight are at a higher risk for developing CTS.
The symptoms of CTS affect the thumb, index, middle and ring fingers. The symptoms can affect just one or all of the these digits. Patients can feel a variety of sensations including numbness, pins & needles and shooting pains. People describe the feeling as their hands being dipped in a bowl of boiling water. The symptoms can travel up the arm and affect the forearm. In most people the symptoms get can be worse at night. They find they have to shake their hands about to relieve the pins & needles or place their hands on a cold surface. As the condition worsens people may find it difficult to perform find tasks such as doing the buttons up on their clothes or pick up coins off a table.
When you come to clinic a thorough history and examination is usually sufficient to diagnose the problem. After your clinic appointment you will be probably be referred for Nerve Conduction Studies which are a test for looking at how the electrical signals are being transmitted along the median nerve. When the median nerve gets compressed this causes carpal tunnel syndrome.
Wait and See
The first option for treatment is to see how things go without any intervention. On occasion symptoms can settle, especially if you refrain from a repetitive movement which causes CTS.
Night splints
Wearing splint at night can relieve symptoms initially at night and then help daytime symptoms.
Keyhole surgery
This can give short lived benefit but cannot fully address the basic problems of arthritis.
Injection
A steroid injection into the wrist can settle symptoms, and many people do not require any more treatment.
Surgery
If all the above fails then the final step is to proceed with a carpal tunnel decompression.
Aftercare
Following the operation, you will normally have a bulky dressing covering your wound. This is then removed to reveal the sticky dressing at 48 hours until 14 days following your operation. The stitches will dissolve and do not require removal. You will require a wound check either at the hospital or your GP practice at 14 days.
After the procedure it can take up to 3 months for full grip strength to recover and for the scar sensitivity to settle down.
Infection
(1%) is a risk with all surgery. In the majority of cases these are infections around the wound and can be treated with a course of antibiotics. The more unusual deep-seated infections however can require admission to hospital and surgery to
clean the wound out if necessary.
Swelling and Stiffness
Can remain for many months following surgery. It is important to elevate the limb and keep all joints that are not immobilised with a splint or dressing, active.
Nerve Injury
Is a potential but very rare risk with this surgery. Often the nerves at greatest risk are the tiny nerves supplying skin in the area of the wound and cutting through these may result in an area of numbness that is not often troublesome.
Recurrence
Is a rare complication.
Complex Regional Pain
Syndrome is an extremely rare (1%) complication that can follow any injury or surgery to a limb. In this situation the nerves in the arm over react to the point where the hand becomes very painful, swollen and sensitive. This condition does improve with time but can be problematic for many months.
