What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) is a common condition caused by pressure of the median nerve as it passes through the Carpal Tunnel at the front of the wrist. Irritation of the nerve can cause tingling and numbness in the hand and sometimes weakness of some of the hand and thumb muscles.
What causes Carpal Tunnel Syndrome?
In most cases it is unclear why it occurs but there are some factors that can be linked to the condition:
- Diabetes, Pregnancy, Underactive Thyroid
- Bone or arthritic conditions of the wrist such as Osteoarthritis, Rheumatoid Arthritis or wrist fractures
- Heavy or repetitive activity may exacerbate symptoms
What are the symptoms?
- Tingling, numbness or pain may be felt in the thumb, index and middle fingers and discomfort may also be felt in the forearm
- Weakness of the muscles at the base of your thumb can affect your grip and cause you to drop objects. Fine finger movements such as doing up buttons and zips may also become difficult
- Symptoms are often worse at night and are relieved by shaking the hand. Other daytime activities such as driving, cycling and reading may make the symptoms worse
How is it diagnosed?
Most cases can be diagnosed following an examination of your wrist and hand. You may also be sent for Nerve Conduction Studies which are electrical tests to measure how signals are passed along the nerve.
What is the treatment?
There are a number of different treatment options available:
- Activity modification: Try and identify any activities which make your symptoms worse and then modify them to try and reduce excessive wrist bending and stretching
- Wrist Splints: A removable wrist brace to keep the wrist straight may help your symptoms. It is usually worn at night but can be used during the day when you are performing aggravating activities
- Steroid Injection: This is an injection of a steroid and local anaesthetic around the nerve in the carpal tunnel and can relieve symptoms at least in the short term in most people
- Surgery: Surgery may be recommended
Please remove all jewellery from your hand before the day of your surgery. Tight rings may need the help of a jeweller to remove. Ensure that your hands and nails are clean and that any acrylic nails or nail varnish are removed.
Surgery is usually performed under local anaesthetic. This means you are awake and the palm of the hand is numb. A tourniquet is usually used on the arm which is tight for about ten minutes. The surgical drapes mean that you will not need to see the surgery. Most people prefer this.
The ligament is released with an incision at the base of the palm. The aim is to prevent worsening symptoms and to improve current symptoms.
Risks of surgery
All surgery has risks and these may vary with your individual circumstances. The following is a general guide.
- Stiffness and swelling
This is common to a degree and can be reduced by elevation of the hand and moving the fingers.
- Scar tenderness
The position of the scar means that it can be tender on pressure for up to six weeks and occasionally more.
- Pillar pain
This is discomfort at either side of the scar at the base of the hand and is usually felt when putting pressure on the hand. This usually improves on its own but can take up to three months to settle.
This is rare after hand surgery (less than one per cent of cases) but can be treated with antibiotics and usually resolves quickly.
- Nerve Injury
This is rare ( less than one per cent of cases) and may result in numbness over the base of the thumb.
Some blood on the dressing is common but significant bleeding is rare.
- Persistent symptoms
This is variable and can depend on the amount of damage to your nerve before surgery. Some people do not experience any improvement.
This is uncommon but can lead to further symptoms.
- Complex Regional Pain Syndrome (CRPS)
This is an abnormal reaction to surgery which can lead to longstanding pain and stiffness and swelling. Severe CRPS is rare but can make you feel worse than before surgery and be difficult to treat.
The local anaesthetic will wear off a few hours after surgery. Simple pain killers are usually all that is required and it is advisable to take these regularly at first. If you experience any severe or continuous pain or feel unwell please contact your doctor. Pain over the incision generally improves over the first two weeks but in some cases lasts for longer.
You will be provided with a sling to wear for the first few days after the operation. This needs to be removed regularly so that you can stretch your arm above your head and bend and straighten your elbow. It is important to keep your hand elevated to aid in the removal of swelling and prevent stiffness of your fingers.
After the operation your hand will be in a large bandage. An appointment will be arranged for two to seven days after your surgery with the Hand Therapist in the Therapy Department, Yeovil Hospital to replace this with a lighter dressing. If you are unable to attend this please contact you GP surgery to arrange for your bandage to be reduced. All dressings should be kept clean and dry and covered with a plastic bag when washing until the stitches are removed.
When can I use my hand?
You can use your hand normally for light functional tasks whilst in the bandage. It is also important to keep your fingers moving by stretching open your hand and then making a first regularly during the day. Avoid pushing up from a chair and heavy gripping tasks for the first few weeks after your surgery.
When will my stitches be removed?
Your stitches will usually be removed about 10 days after your surgery and is normally done by your Hand Therapist. In some circumstances your stitches will be dissolvable, this will depend on your surgeon. You will be advised by your hand therapist which type of stitches have been used, and how to remove them two weeks after the operation. Once the wound is fully healed you will be able to wash your hand and start massaging the scar with an aqueous non-perfumed moisturising cream.
When can I return to driving and go back to work?
Following the removal of your stitches you can return to driving as long as you are comfortable and have enough strength and control to drive safely. How quickly you return to work depends on your job.
Generally light activity/secretarial work will be at about two weeks and heavier activity at four to six weeks.
The Hand Therapy Service is available Monday to Friday 8.30am-4pm
If you have any questions or require further information or advice during the above hours please contact:
Therapy department 01935 384 358
If you have any serious concerns outside of these hours please contact your GP, Accident and Emergency or Minor Injuries Unit.
Further information is available online at:
- NHS Choices Carpal Tunnel Syndrome
- Arthritis Research UK Carpal Tunnel Syndrome