Carpal Tunnel Syndrome
What is carpal tunnel syndrome?
Carpal Tunnel Syndrome (CTS) is a condition caused by increased pressure on the median nerve at the wrist. This causes various symptoms, such as numbness, tingling and pain in the hand and forearm. It can also cause weakness in the thumb.
Causes of carpal tunnel syndrome
There are many known causes of CTS, but most cases have no obvious cause identified. Since Diabetes and Thyroid disease can cause CTS we often ask your GP to test you for these prior to referral. Some causes are reversible and therefore symptoms can be managed until such a time as they improve (i.e. pregnancy).
Symptoms of carpal tunnel syndrome
CTS causes pain, numbness and tingling in the thumb, index, middle and ring finger. The most trouble is seen at night and during certain activities. In severe and long-term cases, there may be permanent loss of feeling and strength in the thumb.
How is it diagnosed?
The story and examination of a patient with CTS is often very suggestive and may be all that is required. If the diagnosis is in doubt we will refer you for nerve conduction tests which will also tell us how severely the nerve is damaged.
Treatment of carpal tunnel syndrome
Change of employment status, rest, wearing a wrist splint or anti-inflammatories can all help to improve symptoms. An injection of cortisone into the carpal tunnel can help, especially if the nerve compression is associated with inflammatory conditions.
During the operation we release the carpal tunnel to provide more space for the median nerve. This is performed through a small incision in the palm, under local or regional anaesthesia. Local anaesthetic is injected directly into the palm and regional anaesthetic is given as an injection into the arm by the anaesthetist. We tend not to recommend general anaesthetic (asleep) as there are risks and recovery is slower.
After surgery a bulky bandage is applied that can be removed around one week at the earliest. Your GP practices nurse can remove the stitches and dressings at 2 weeks postop. You can then begin to use your hand normally again. Usually, the pain and tingling settle quickly after surgery, although the scar may remain sensitive for longer. Any loss of strength will improve very slowly.
Mr Sam Vollans
Consultant Orthopaedic Surgeon
I graduated from the University of Leeds and completed my specialist training in Yorkshire. Following this, I undertook further training in both elective and trauma shoulder & elbow surgery in Sheffield & Europe.
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