Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition which develops when the median nerve (the main nerve running through your wrist from your forearm to your hand) comes under pressure. Essentially, it is a pinched nerve in the wrist. Symptoms include pain, tingling and numbness in the fingers, hand and arm.

The carpal tunnel is a passageway that protects your median nerve and nine tendons at your wrist.  When there is swelling in the tunnel, it puts pressures on the nerve.  Carpal tunnel syndrome occurs when the pressure from the swelling increases sufficiently to affect the way the nerve works.

Carpal tunnel syndrome is very common, and in most instances can be treated effectively.

Causes

Often the direct cause of carpal tunnel syndrome in an individual is unclear, and there can be more than one contributing factor.  There are a number of ways that increased pressure in the carpal tunnel can occur, including:

  • Swelling of the lining of the tendons in the tunnel (called tenosynovitis)
  • Swelling associated with dislocations, fractures or arthritis in the wrist joints
  • Swelling arising from the wrist bending continually over a period of time

Factors that may contribute to the development of carpal tunnel syndrome, sometimes in combination, include:

  • Diabetes
  • Obesity and sudden weight gain
  • Age – the incidence of carpal tunnel rises in the 45-60 age group

Pregnant women also often experience carpal tunnel syndrome, although the symptoms usually resolve after they give birth.  In general, carpal tunnel syndrome is more common in women than in men.

Symptoms

Symptoms of carpal tunnel syndrome include pain in your fingers, hand and arm, and tingling and numbness in your thumb, index, middle and ring fingers. You may experience symptoms during the day when undertaking activities such as driving, but usually the symptoms are worse during the night and they may even interfere with sleep.  You may find that your grip is weaker or that you drop things more frequently.  In severe cases, there may be shrinkage of the muscles at the base of your thumb and a permanent loss of sensation.

You should consult your local GP or contact the Hand Centre if you:

  • Experience pain, tingling or numbness in your arm, wrist or fingers, especially when you perform tasks that involve prolonged gripping or bending your wrist continually or repetitively  (eg driving, writing, cutting or swiping)
  • Find your symptoms are worse at night or when you first wake up
  • Find your symptoms get better when you shake your hand
Diagnosis

Carpal tunnel syndrome is diagnosed by taking a detailed history and conducting a thorough examination, often supported by a nerve conduction study (usually carried out by a neurologist).  Not all sufferers exhibit the classic signs of carpal tunnel syndrome, so it is important that you report in detail on daily activities – especially those activities that involve repetitive or prolonged hand and wrist movements – and their impact on your symptoms.

In order to diagnose carpal tunnel syndrome, your specialist will seek to rule out any underlying medical disorders that may be exacerbating or contributing to the condition, including tenosynovitis, fractures or dislocations, thyroid disease and arthritis.  He or she may order specific tests to check for these other conditions. It is important that such underlying causes are identified as the treatment for these disorders will usually be different from that of carpal tunnel syndrome, and if they are left untreated, your symptoms will not resolve.

If your specialist orders nerve conduction studies, he or she will likely refer you to a neurologist. The neurologist will place electrodes on your hand and wrist, and apply small electric shocks to measure how fast a signal passes through the nerves that control sensation and movement. You may find the shocks a little uncomfortable but they are not painful.

Treatment

In mild cases of carpal tunnel syndrome, splinting the wrist (particularly at night)and/or stretching exercises may be sufficient to reduce pressure on the nerve and relieve pain. It also usually helpful to avoid or reduce aggravating positions and activities. In moderate to severe cases of carpal tunnel syndrome, surgery is most often the best option. Where another condition is identified as causing the symptoms of carpal tunnel syndrome, treating that condition will relieve the symptoms.

Conservative treatment

If your carpal tunnel syndrome is mild and you choose a non-surgical treatment, the hand surgeons and hand therapists at The Hand Centre will work with you to determine the best management plan for you. Such a plan might involve:

  • Limiting movement and resting the affected hand and wrist for 2-6 weeks, allowing swollen tissues to shrink and thus relieve pressure on the median nerve.
  • Splinting that prevents the affected wrist from bending, especially at night.  Many patients report fewer symptoms after splinting, often within days of first wearing the splint.
  • Hand and finger exercises.
  • Self-management strategies such as advice on ways to use your hand so as to reduce pressure on the nerve
  • Steroidal injections to reduce inflammation, shrink swollen tissues and relieve pressure on the median nerve.  These are often most beneficial for pregnant women, providing temporary relief until the symptoms resolve after they give birth.
Operative treatment

If you choose surgical treatment for your carpal tunnel syndrome, you’ll have a procedure called a carpal tunnel release. Carpal tunnel releases can be performed in a hospital or a day surgery, either under a general anaesthetic or under sedation with a local anaesthetic. It is most common for the surgery to be performed under a general anaesthetic.

If you are a public patient, you will go on a waiting list for the carpal tunnel release. The waiting time can be up to two years. If you are a private patient, you can generally have your carpal tunnel release at a time that is convenient to you, usually within a few weeks of diagnosis.

During a carpal tunnel release, your surgeon will make a short incision – usually only a couple of centimetres long – in the palm of your hand and carefully cut through the ligament that forms the roof of the carpal tunnel. Once this is done, your surgeon will suture up the cut and apply a bandage around your palm and wrist, leaving your fingers and thumbs free. The procedure takes approximately 20 minutes, although the operation itself will be longer, according to whether you are having a general or a local anaesthetic.

At the Hand Centre, carpal tunnel releases are usually performed under general anaesthetic.  The hand surgeons at the Hand Centre have extensive experience with carpal tunnel releases, and can perform bilateral (two hands at once) as well as unilateral (single hand) releases.

Post-operative treatment

Following a carpal tunnel release, you will usually be able to go home within hours of your surgery, once you have recovered from the anaesthetic. Your hand will be bandaged, and you will have to keep the hand dry for a week or so. You will likely be given pain medication for the first few days and a list of instructions about what to do. If you have non-dissolving sutures, they will be removed 10 to 14 days after your operation.

With the pressure on the median relieved by the carpal tunnel release, the symptoms of carpal tunnel syndrome should resolve following surgery. You will be unable to drive for a week or so following the surgery, and when you return to your usual activities, including employment, depends on the nature of those activities. The usual timeframe for a return to work is 2 to 3 weeks.

You should see your surgeon 4 to 6 weeks after your operation. You may experience soreness at the site of the cut during this time, and you may continue to have mild discomfort for several months. The entire healing process takes about 6-12 months.

You will not usually require hand therapy following a carpal tunnel release, unless, for example, you have an underlying condition requiring therapy, have significantly reduced grip strength, have ongoing pain or require assistance in reducing post-operative scarring, or if you are returning to an activity that exacerbates your carpal tunnel syndrome. If you require therapy, the hand surgeons and hand therapists at The Hand Centre will work with you to determine the best therapy plan for you.

Suite 4, Level 4, 171 Bigge St, Liverpool NSW 2170