A B C D E F G H I J K L M N O P R S T U V W

CARPAL TUNNEL SYNDROME

What is Carpal Tunnel Syndrome ?

This condition is a pain and tingling caused by pressure on the median nerve. This nerve runs across the front of the wrist joint into the palm of the hand. It carries the nerve fibres for feeling in the thumb, index and middle finger. It runs beneath a tough ligament, the flexor retinaculum, which forms the roof of the carpal tunnel whose floor is formed by the front of the wrist joint. Next to the nerve run the sinews which close the fingers. If the tunnel gets smaller (for example, in arthritis), or if the sinews get swollen for any reason, the median nerve will be squashed. This causes painful pins and needles and numbness usually in the thumb, index and middle fingers, and occasionally in all the fingers of the hand. An aching pain may spread up through the forearm to the elbow and even as far as the shoulder. Symptoms are typically worse at night and first thing in the morning. You may tend to drop things in the kitchen and if your thumb or fingertip is numb, you may burn or cut yourself without noticing it.

How does Carpal Tunnel Syndrome occur ?

In most people we don't know why the carpal tunnel becomes too small for the nerve. It sometimes occurs in pregnancy where there is a tendency to fluid swelling of the tissues generally. It may also occur in the condition of acromegaly where too much growth hormone causes many tissues to increase in size. An underactive thyroid gland can also cause tissue swelling. Finally, a severe injury or dislocation to the wrist bones or the bruising or swelling due to a fracture of the wrist can cause pressure on the nerve.

Treatment Involved for Carpal Tunnel Syndrome

A splint worn at night which keeps the wrist straight or slightly cocked up often controls the severe pain. Anti-inflammatory drugs also help. If these two measures do not work, then some doctors will advise a local anaesthetic and cortisone injection into the front of the wrist. The theory behind this treatment is that the cortisone counteracts the inflammation and swelling in the carpal tunnel, allowing more room for the nerve. If both these treatments fail, then surgery is usually necessary. This takes the form of a small cut on the front of the wrist running up towards the palm of the hand which can measure 1 to 2 inches (2.5 to 5.0 cm) long. Some specialists will perform this procedure by keyhole surgery, which results in a smaller scar. The operation is done under either local or general anaesthetic by discussion with the surgeon. Usually you can go home the same day, with the hand and wrist bandaged up. The stitches are left in for about 2 weeks and during this time you need to keep the wrist and hand dry. For the first few days after the operation, it helps to keep the hand elevated across the front of the chest on the opposite shoulder, using some form of sling support.

During Treatment of Carpal Tunnel Syndrome

If there is increasing pain after operation, then you should return to the doctor for the wound to be inspected, as there may be some bruising or occasionally infection. There are no serious side-effects of treatment. The scar on the front of the wrist in some people is tender but this almost always settles down with time and local massage. Full grip strength takes a few months to return to normal.

After Treatment of Carpal Tunnel Syndrome

The recurrence rate of this condition is very low and there are no delayed complications.

If Carpal Tunnel Syndrome is Left Untreated

If the nerve is compressed for a long time, then it is less likely to recover. The numbness and tingling in the fingers may even be permanent and there may be weakness of one of the muscles which moves the thumb. This is more likely to occur in older patients.

Effects on Family of Carpal Tunnel Syndrome

You will need some help and support while your hand is bandaged, particularly if it is your dominant hand, or if both hands are operated upon at the same time.