Carpal tunnel syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is a condition affecting one of the main nerves that supplies strength and feeling to the hand (median nerve). This nerve passes through a tight tunnel at the wrist along with many of the hand tendons. If the pressure in this tunnel increases the nerve will become irritated and symptoms such as pins and needles, pain and loss of sensation will occur in the hand. This pain can become very severe and often disrupts sleep or day to day activities.

In most cases CTS occurs for no other apparent reason, however it can be caused by previous wrist injuries. It can also be associated with thyroid disease, diabetes, and pregnancy. Other conditions such as neck arthritis may give similar symptoms, your clinician will discuss this possibility with you.

The diagnosis is usually made by clinical examination and occasionally special nerve tests being performed (nerve conduction studies).

What can I do to help myself?

  • Wear a wrist splint to help prevent the wrist from bending and putting too much pressure on the tunnel
  • Be aware of your wrist position and try to avoid prolonged periods of bending at the wrist

What can physiotherapy do to help?

Physiotherapy can help analyze and evaluate your working, home and sporting conditions to try and adapt the things you do to help prevent putting added pressure on the tunnel. Physiotherapy can also help to work with splints to again further relieve the pressure on the tunnel.

If surgery is required, physiotherapy will help to increase your movement and strength therefore aiding you gradually to return to all your activities of daily living.

How can surgery help?

If simple measures have not settled the symptoms surgery may be offered. Surgery may be performed under general or local anaesthetic, both usually as day cases. Depending on patient and surgeon’s preferences the surgery may be “open” or “endoscopic”. Both forms of surgery release the tight band of tissue forming the roof of the tunnel around the nerve at the wrist, allowing the pressure on the nerve to be reduced.

Open surgery is frequently performed under local anaesthesia. A 3 to 4cm wound is made in the palm of the hand. The nerve is released and the wound closed with dissolving sutures. A bandage is worn for 5 days and following this the hand may be used so long as the wound is kept clean and dry. By 2 weeks following surgery the wound in usually healed well enough to allow return to work and driving, however tenderness can be expected in the palm of the hand for several weeks following the surgery. In most cases in both hands are involved the second side is operated on once satisfactory recovery has been made, this is usually 8 weeks onwards.

Endoscopic or “key hole” surgery performs the same release of the tight tunnel through a small wound further up the wrist. The wound is less than 1cm in length. Dressings are removed after 1 day. Since the hand has no wound, both hands may be operated on at the same time. Following the surgery there will still be tenderness in the hands (deep bruising), but patients are encouraged to use their hands as quickly as possible. Return to work and daily activities can be quicker with this technique, but it is not suitable for every patient.

The nerve symptoms often settle within a period of weeks, but full recovery may take considerably longer.

The 2 different surgical wounds for carpal tunnel release, open (left) and endoscopic (right).