Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a condition caused by compression of the median nerve as it passes through the carpal tunnel, a narrow passageway in the wrist. The median nerve controls sensation and movement in parts of the hand. When this nerve is compressed, it can lead to symptoms such as pain, numbness, and weakness in the hand and fingers.

Common carpal tunnel symptoms include:

• Numbness or tingling in the thumb, index, middle, and ring fingers
• Pain or aching in the wrist and hand, sometimes extending to the forearm
• Weakness in the hand, leading to difficulty gripping objects
• A sensation of “pin and needles” in the fingers
• Symptoms often worsen at night or after activities that involve prolonged wrist movement

Carpal tunnel syndrome is caused by pressure on the median nerve within the carpal tunnel. This pressure can result from various factors, including:

• Repetitive Hand Movements: Activities involving repetitive wrist motions, such as typing or using vibrating tools, can contribute to CTS.
• Wrist Anatomy: A smaller carpal tunnel or bone dislocations can lead to increased pressure on the median nerve.
• Health Conditions: Conditions such as diabetes, rheumatoid arthritis, and thyroid disorders can increase the risk of CTS.
• Fluid Retention: Pregnancy or other conditions that cause fluid retention can lead to swelling in the carpal tunnel.
• Injury: Wrist fractures or trauma can also contribute to the development of CTS.

Non-surgical options for carpal tunnel syndrome treatment may include:

• Wrist Splinting: Wearing a wrist splint, especially at night, can help keep the wrist in neutral position, reducing pressure on the median nerve.
• Nonsteroidal Anti-inflammatory Drugs (NSAIDS): Medications like ibuprofen can reduce inflammation and relieve pain.
• Corticosteroid Injections: Injections can reduce inflammation and swelling around the median nerve, providing temporary relief.
• Activity Modifications: Reducing or modifying activities that exacerbate symptoms can help manage CTS.
• Physical Therapy: Exercises to stretch and strengthen the wrist and hand muscles can alleviate symptoms.

Surgery for carpal tunnel syndrome should be considered when:

• Non-surgical treatments fail to provide relief
• Symptoms persist for several months or worsen over time
• There is significant weakness or muscle wasting in the hand
• The patient experiences severe pain that interferes with daily activities or sleep

Surgery is aimed at relieving pressure on the median nerve by cutting the ligament that forms the roof of the carpal tunnel.

Recovery time after carpal tunnel release surgery varies depending on the type of surgery and individual factors. Generally:

• Endoscopic Surgery: Patients may return to light activities within a few days to a week, with full recovery taking several weeks.
• Open Surgery: Recovery might take a bit longer, with most patients returning to normal activities within 4 to 6 weeks. Full recovery, including the return of strength and sensation, can take several months.

Endoscopic carpal tunnel surgery involves making one or two small incisions in the wrist and using a camera (endoscope) to guide the surgeon as they cut the ligament to relieve pressure on the median nerve. This method usually results in a faster recovery and less post-operative pain. Open surgery involves making a larger incision in the palm of the hand to directly view and cut the ligament. While open surgery is effective, it may result in a longer recovery time and more noticeable scarring compared to the endoscopic approach.

Yes, while carpal tunnel release surgery is generally successful, carpal tunnel syndrome can recur in some cases. Recurrence is rare but can happen due to incomplete release of the ligament, scar tissue formation, or if the patient continues activities that stress the wrist. If symptoms return, further evaluation and treatment may be needed.

Preventing carpal tunnel syndrome involves minimising stress on the wrist and hand:

• Ergonomic Adjustments: Ensure that workstations are set up to promote a neutral wrist position and proper posture.
• Regular Breaks: Take frequent breaks during repetitive activities to rest and stretch the hands and wrists.
• Wrist Positioning: Avoid bending the wrist too far up or down. Keeping the wrist in a neutral position can reduce strain.
• Hand Exercises: Strengthening and stretching exercises for the hand and wrist can help maintain flexibility and reduce the risk of CTS.

During recovery after carpal tunnel surgery, patients can expect:

• Initial Rest: The hand and wrist will need to be immobilised for a short period, usually in a splint or bandage.
• Pain and Swelling: Some pain and swelling are normal, and pain relief medication may be prescribed.
• Physical Therapy: Exercises may be recommended to regain strength and flexibility in the wrist and hand.
• Gradual Return to Activities: Patients should gradually return to normal activities, avoiding heavy lifting or strenuous wrist movements until fully healed.
• Follow-Up Visits: Regular follow-up visits with the surgeon will ensure proper healing and monitor progress. Full recovery can take several weeks to months, depending on the individual case.