Carpal Tunnel Release

What is Carpal Tunnel Syndrome?

It is a common condition that causes pain, numbness and burning/ tingling sensation in the hand and fingers.

If severe it can cause weakness in the hand as well.

What is the Carpal Tunnel?

The carpal tunnel is a small tunnel made of the ‘transverse carpal ligament’ at the top of the wrist. Inside the tunnel lie several tendons and a nerve (the median nerve) which control sensation and movement in your hand.

In Carpal Tunnel Syndrome a build up of swelling and pressure inside the tunnel reduces the space that the tendons and nerve have and can compress the nerve.

It is the compression of the nerve which causes the pain, tingling and numbness in the hand.

Why does it occur?

The exact cause of Carpal Tunnel Syndrome isn’t always known but certain things can be linked to high incidence of the condition:

• Family history: some research shows a genetic link to carpal tunnel syndrome
• Certain health conditions: for example diabetes, rheumatoid arthritis, gout, hypothyroidism, obesity, oedema/ swelling
• Pregnancy: due to fluid retention (swelling)
• Certain injuries: to the hand or wrist such as sprains, ligament injuries or fractures can cause swelling in the wrist which may put pressure on the nerve
• Certain activities which involve lots of repetitive wrist movement forwards and backwards

What are the symptoms?

Symptoms include:

• Tingling or numbness in the thumb, index, middle and half of the ring fingers.
• Pain

Other symptoms include:

• aching/ discomfort in the hand forearm.
• Burning/ prickling sensation
• Dry skin
• Swelling
• Changes in colour of the skin
• Weakness in the thumb
• Wasting of the muscles of the thumb

What tests might be done?

Your doctor can diagnose carpal tunnel syndrome by carrying out a few simple tests and by asking you about your symptoms.

On occasions ‘Nerve Conduction Studies’ may be carried out to confirm your diagnosis or check that there isn’t a problem elsewhere.

Nerve Conduction Studies include small electrodes (metal discs) being placed on your arm and a small electrical current being sent through. This tells us how fast the signals are being sent through your nerves and will help to identify where the nerve problem is and how serve it is.

What is the treatment?

Carpal Tunnel Syndrome can be managed non-operatively but in some cases surgery may be required.

Non-operative Treatment:

• Splinting: Splints can be purchased or provided by a therapist which rest your wrist in a straight/ neutral position in which the carpal tunnel is at its widest and preventing it from bending and applying further pressure on the nerve.
• Advice/ lifestyle changes: Sometimes being given advice on carpal tunnel syndrome and the types of activities to avoid can help reduce symptoms and allow the inflammation to settle down.
• Steroid Injections: These can be injected into your wrist to help relieve the swelling and pressure around the nerve.

Operative Treatment:

Carpal Tunnel Decompression: Surgery is usually recommended for severe symptoms / symptoms that have lasted for six months or more.

During the operation the surgeon makes an incision in the wrist and cuts the ligament that forms the roof of the tunnel which helps to relieve the pressure on the nerve.

What to expect after your operation.

This surgery is normally performed as a day case under a general anaesthetic or regional block (the arm is made numb through an injection. You will be sent home with light bandaging.

After your operation it is recommended that you ensure you maintain movement in your wrist and fingers gently to prevent them from stiffening up.

If after your surgery you have any problems with weakness or sensitive scarring you may need to see a therapist. Your surgeon will advise you on this.

Things to consider before having a carpal tunnel release:

• There is a small risk of infection
• In some cases the operation may not work/ may need repeating
• In some cases where the nerve has been severely damaged there may be permanent and irreversible changes in the hand including tingling/ numbness and or loss of strength/ control
• Risk of problematic scar tissue. After the operation there is a risk that you may have problems with scarring including tender/ sensitive scarring. Thick/ hard scarring causing reduced movement
• Risk of some stiffness of the wrist and fingers following the operation
• Risk of Reflex Sympathetic Disorder (RSD). Can also be known as Chronic

Regional Pain Syndrome (a malfunction of the nervous system that controls your pain)