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What is Carpal Tunnel Syndrome?


Carpal Tunnel Syndrome is a condition of the hand, where the nerve ( called the median nerve) is compressed  under a tight band ( called the flexor retinaculum) of tissue at the wrist.  This causes a pins and needles sensation in the thumb, index, middle and part of the ring fingers.  This results in cramps at night, which cause the person to wake up.  Often these patients will shake the hand to improve the circulation to the nerve and to get back to sleep.  These patients are also known to drop small objects, which they cannot feel very well due to diminished sensation between the thumb, index and middle fingers.  Driving can be a problem and prolonged periods of driving often result in pins and needles in the hand.  The same symptoms can also occur with holding the phone for a long time.


What conditions can mimic Carpal Tunnel Syndrome?


Compression of the nerves anywhere in the upper limb can mimic these symptoms.  Nerves are often trapped at their exit from the neck, above the first rib or around the elbow.  The commonest area for the nerve to be trapped is, however, the carpal tunnel.


Does this condition cure itself?


If this condition is present for a short time it can simply be caused by significant prolonged periods of unusual work, pregnancy, conditions of fluid retention, kidney problems, thyroid hormone imbalance and diabetes.


Diabetes can aggravate this problem and give rise to similar symptoms.


Can this condition cause permanent problems or damage?


Carpal Tunnel Syndrome can cause permanent nerve damage.  This is especially true in patients who have had the symptoms for many years.   These patients lose sensation in the thumb and some of the fingers, but they can also lose some of the muscle bulk at the base of the thumb resulting in difficulties with movement of the thumb.





What are the treatment modalities for Carpal Tunnel Syndrome?


Initial short-term symptoms are controlled with the use of splints and occasionally by the use of steroid injections.  Diagnosis can be confirmed by performing nerve conduction studies, although these are not always necessary.  Surgery is the last resort for nerves that do not improve.  Patients over a certain age group may not be suitable for this operation or may not gain much with relief because of the prolonged symptoms. However, the operation can stop the nerve deteriorating any further provided there is no compression in the neck.


What are the kinds of operations that can be carried out for Carpal Tunnel Syndrome?


Carpal tunnel release is the classic operation described for carpal tunnel syndrome.  This is carried via an incision in the palm.  This can be performed under local anaesthetic.


Endoscopic (keyhole surgery) carpal tunnel is also a well established technique and can be used in patients who wish to go back to work early.  This technique may not be suitable in some patients.


The operation for open carpal tunnel decompression is carried out under a local or general anaesthetic.  An incision is made in the palm of the hand; the gristle (flexor retinaculum) above the nerve is divided making more space for the median nerve.  This is then sutured and a small bandage is applied.


Problems following the operation


Complications can occur with any operation, they are, however, quite rare with carpal tunnel syndrome. Complications can include nerve damage.  Other problems include-


 Pillar pain, which is pain on either side of the scar.  This pain can take a few months to settle down and is especially felt when pushing oneself up from the table or a chair. 


Stiffness can occasionally be a problem and exercises are prescribed in the early days to ensure that stiffness does not occur.  It is very important to carry out these exercises.


Cold intolerance:  The hand can be insensitive to cold weather for a few years following surgery.  This is especially true in smokers. 


Nerve recovery can take up to three years depending on the age group of the patient.  In most patients without permanent nerve damage the sensation is normal and symptomatic relief is almost immediate.


Loss of power.  There is a weakness of the hand following this surgery.  This generally improves over the next six to nine months as the scar remodels and becomes stronger.


Chronic regional pain Syndrome: This is unpredictable and occurs in a small percentage of patients that have surgery or injury. This is a reaction of the nerves and blood vessels. Anyone can get this  despite  good treatment. Some patients react to injury or surgery in this way and recovery can be prolonged and protracted. One may never recover completely.


Endoscopic Carpal Tunnel


Keyhole surgery for carpal tunnel release can be carried out in patients who wish to go back to work earlier. This is carried out via a single port at the wrist.  Recovery from this procedure is quick; however, at approximately 12-16 weeks, both groups of patients would have done equally well.


Return to work


Patients can return to light work from two to six weeks following surgery, provided this is uncomplicated. Patients involved with heavy work may need up to 12 weeks off work.                            


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