Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome (CTS)?
The carpal (wrist) tunnel is formed by the wrist bones, forming an arch on one side, and the a strong ligament on the other side. The carpal tunnel is mostly filled by the tendons that bend your fingers and thumb. The median nerve is also in the tunnel. Conditions that increase the thickness of the tendons or decrease the size of the tunnel put pressure on the nerve, causing carpal tunnel syndrome.
The median nerve supplies sensation (feeling) to the thumb, index & middle fingers, and half of the ring finger. It also supplies power to the muscle at the base of the thumb that allows you to pull your thumb towards your forearm.
What causes of carpal tunnel syndrome?
Carpal tunnel syndrome most commonly occurs in women over the age of 40 years and tradespeople who use vibrating tools. The tendons in the carpal tunnel gradually increase in thickness as we age and this can lead to median nerve compression.
Carpal tunnel syndrome is only considered work-related when ALL three of these factors are present in the work environment:
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Repetitive strong grasp
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Vibrating tools
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Cold exposure
Risk factors for carpal tunnel syndrome
Diabetes Smoking
Hypothyroidism Rheumatoid/Psoriatic Arthritis
Family with CTS Wrist thumb arthritis
Wrist fractures High body mass index
Injury to the hand. Tumours (rare)
Gout
What are the signs & symptoms?
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Numbness, tingling or pins and needles of one or more fingers.
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Weakness of grip.
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Easily fatiguing with repetitive manual tasks.
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Loss of dexterity, clumsiness and dropping things (e.g. difficulty doing up buttons or jewellery).
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Pain - aching, burning or electric, sharp, shooting pain that may radiate into the hand, fingers, wrist, forearm or up to the shoulder. The pain may occur at night, during the day or several hours after an activity that provokes the symptoms (e.g. manual work, repetitive tasks, a long drive, an injury to the hand or wrist).
In younger adults there may be no numbness or tingling and only vague aching pain, weakness and muscle fatigue with repetitive tasks.
Treatment Options
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Non-operative treatment
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Carpal tunnel release surgery
Non-operative treatment
For mild symptoms
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Wrist splint at night to prevent sleep disturbance and during the day for repetitive manual activities.
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Activity modification - avoid long periods of repetitive gripping activities (break these tasks into shorter time frames); avoid vibration exposure (long drives, prolonged use of vibrating tools)
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Cortisone (steroid) injection may greatly reduce the symptoms for a month or two.
Carpal tunnel release surgery
Most people will eventually require surgery as the natural course of carpal tunnel syndrome is to slowly get worse. Surgery is usually recommended when the symptoms are preventing sleep or interfering with daily activities .
Carpal tunnel release surgery is extremely safe and reliable. is performed as a day surgery procedure under sedation with local anaesthetic or general anaesthetic.
The procedure takes approximately 45 minutes. Expect to arrive at the hospital 2 hours before surgery and leave the hospital 2 hours after the surgery.
The carpal tunnel release is performed through a 2.5cm skin incision at the base of the palm. The ligament forming one side of the tunnel is divided. This allows
the tunnel to expand increasing the size of the tunnel by 20% and relieving the pressure on the median nerve. The gap in the ligament fills with scar tissue and heals. This process takes approximately 4 months.
What to expect after surgery
When you go home your hand will be numb for many hours due to the anaesthetic. This will keep your pain to a minimum. Strong pain relief is usually only needed in the first 48hrs. The bandage must be kept clean and dry until you are able to remove the dressing as advised in the instructions given to you on the day of surgery. You may use your hand for light activities.
What about recovery?
2 days: Rest & elevation and pain relief. Very light use of hand only. Keep dry for 2 weeks.
5-7 days: Most people will be able to drive & return to light clerical duties with regular panadol osteo to control discomfort.
2 weeks: Stitches will be removed & you can now wash the hand normally.
3-4 weeks: It will be very difficult to grip and twist (e.g. opening jars) due to pain and lack of strength. Avoid cooking, cleaning, and twisting activities.)
8-10 weeks: You will have a progress review with the surgeon. All light daily activities should now be possible. There will still be pain if you do too much. The scar will still be quite thick and tender. This will take 4 months to resolve.
3-4 months: Most people are pain free and feel that their grip strength is almost normal. Improvements in strength and sensation depend on the how severely the nerve was injured before surgery. Recovery of a sensation (feeling) for a severely compressed nerve can take up to 2 years.
Heavy manual workers may not return to work for 2-4 weeks and shall be on restricted duties for approximately 12 weeks.
What are the risks?
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Recurrence - 5% risk of recurrence in older patients, but younger adults are likely to require a repeat carpal tunnel release during their working life.
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Infection (1%)
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Nerve injury (0.1%)
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Persistent scar tenderness (infrequent)