Surgery can cure carpal tunnel syndrome, relieving frustrating symptoms and preventing the progression to permanent nerve damage.
Carpal tunnel syndrome
Carpal tunnel syndrome occurs when a major nerve to the handis compressed tightly at the wrist. The carpal tunnel is located at the wrist. The wrist has eight small bones that sit together forming a U shape. A thick ligament forms a roof over the U, and thus forms the carpal tunnel. The tunnel contains the tendons that connect muscles in the forearm to the fingers, and a large nerve, the median nerve.
There is not much room in the carpal tunnel, and swelling in the tunnel, like inflammation of the tendons, can result in the nerve being squashed. The nerve can also be squashed in certain positions, like when the wrist is bent forward. Most of us sleep with our wrists bent forward, and the nerve can also be compressed then.
This compression of the nerve causes tingling fingers, and perhaps even pain. This often wakes patients from sleep. Changing position and shaking out the hand may relieve this. The symptoms may eventually worsen, becoming more frequent and annoying. Eventually clumsiness in the hand may develop, and ultimately the numbness may become permanent.
Mild carpal tunnel syndrome with occasional symptoms that reverse quickly does not need surgery. Try avoiding the activities that bring on the tingling or pain. Many patients only get the symptoms at night. A good first line treatment is wearing splints to keep the wrists straight while sleeping. That may relieve the symptoms.
Symptoms that are annoying and frequent need to be treated. It is important to not let the symptoms become so severe that numbness is constant. This can result in permanent nerve damage, that surgery will not correct.
An alternative to surgery is a steroid injection. This can decrease swelling in the carpal tunnel, giving the nerve a little more room. Steroid injections result is usually temporary, but it can put off surgery. Sometimes the steroid injection is a permanent cure.
Surgery is a relatively simple procedure. It is usually performed under a general anaesthetic (asleep), but it can also be performed under sedation (sleepy) or local anaesthetic (completely awake).
A 3-4 cm cut is made just beyond the wrist crease, and this is extended down to the ligament that forms the roof of the carpal tunnel, making more space for the nerve. The skin is stitched, and a bulky dressing is used to wrap the hand and wrist.
Most patients go home on the same day.
Surgery is usually very successful at relieving the intermittent tingling. This is usually immediate. The recovery is slower if the symptoms were present constantly, and feeling gradually recurs in all except the most severe cases.
The cut from the surgery is quite deep, and can be sore for some time. The bulky dressing will stay on for around a week. You will need to be gentle with your hand for the first 4-6 weeks after surgery, and can usually get back to your regular activities after that.
Dr Kotronakis has regular lists at St George Private, Kareena Private, Royal Prince Alfred and St George Hospitals. Carpal tunnel release can be performed at all these hospitals.