Carpal Tunnel Syndrome (CTS)

What is the Carpal Tunnel and Carpal Tunnel Syndrome?
The carpal tunnel is a tight tunnel lying beneath the base of the palm, which carries all the flexor tendons from the forearm to the hand. It also carries the important ‘median nerve’ – a nerve carrying fibres that supply some of the small muscles of the hand and sensation to the thumb and next 2½ fingers. The tunnel is surrounded by very tough ligament.

In normal circumstances, this tunnel is a very snug fit of tendons and nerve. However, if anything happens to increase the volume of the tunnel contents, or decrease the size of the tunnel itself, ‘carpal tunnel syndrome’ may occur. The nerve becomes ‘trapped’, resulting in numbness and tingling (pins and needles) of the thumb and next 2 ½ fingers. In many cases this is worse at night-time and may even cause a pain which can radiate up the whole length of the arm.

In the early stages, the symptoms are reversible but, over time, the muscles at the base of the thumb can become weak and wasted, causing major functional problems for the hand. Some permanent numbness, especially of the finger tips, may also always remain.

Why would I get Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) can affect anyone, except children, at any time in life. The most common cause is fluid-retention, hence the syndrome occurs more commonly during pregnancy and in middle-aged women in response to hormonal changes. The syndrome is also associated with under-function of the Thyroid gland (myxoemedema), and any thickening of the tendon sheaths in this area (as a result of rheumatoid arthritis, ganglions or wrist-fracture) may also contribute to CTS.

It is highly unlikely that you have contributed personally to CTS or that you could have prevented it in any way. Sometimes, similar patterns of symptoms can be produced as a result of repetitive strain injury (RSI), but this, and its treatment, is quite separate from CTS.

What can be done about CTS?
In the early stages of the syndrome, considerable relief can be provided, especially at night-time, by wearing a simple wrist-splint. In patients who have a potentially reversible cause, such as pregnancy, a steroid injection can also provide temporary relief of the symptoms. Where the syndrome is more pronounced, however, surgery to decompress the tunnel is necessary.

The surgery will relieve the feeling of pins and needles and pain, but numbness and weakness could well take longer to recover, especially in the elderly. The surgery involves the cutting of the tough ligament around the tunnel and is usually performed under local anaesthetic as a day case procedure.

How long will it take to recover?
Recovery times vary considerably depending on the exact nature of your symptoms at the time of the operation. Sutures are normally removed by the Hand Therapist a week to ten days post-operatively.

Where the symptoms are treated early, a full recovery of grip strength and sensation is common, and, after time, all symptoms of tingling, pain and numbness will disappear. Recovery can be very slow (6-12 months) and as the nerves grow back, the fingers may feel tingly and even slightly unpleasant. Your grip will be slightly weaker than usual, but this will improve gradually over six months. You will be left with a scar across the palm, and sometimes also the wrist, that may be tender for 6-8 weeks after the operation.

Patients who had very numb fingers or wasting of the thumb muscles before surgery will probably never regain full nerve function.Driving is an issue between you, your insurer and the police. However, you should not contemplate driving while you have any dressings or a splint.

Mr Fleming can discuss the exact nature of your treatment, including procedure details, recovery times and any possible side-effects at a consultation. This will reflect your exact circumstances and needs. The information included here is provided for general guidance only.I do not perform keyhole (endoscopic) carpal tunnel release.

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