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What is carpal tunnel syndrome?
Carpal tunnel is a very common condition caused by pressure on the median nerve, which is one of the main nerves in the hand. The median nerve enters the hand through the carpal tunnel, which is a small space in the wrist. If the tissue inside the carpal tunnel becomes inflamed and swells, it can put pressure on the median nerve, causing pain and numbness.
In most patients, the cause of CTS is not clear. However, you’re at higher risk if you:
- Have diabetes, a low thyroid condition or arthritis in the wrist
- Are pregnant
- Have had a recent wrist injury
Everything you need to know
What are the symptoms of carpal tunnel syndrome?
When the median nerve is under pressure, it can cause a number of symptoms. In milder cases, these can come and go with time and often flare up at night or first thing in the morning. In more moderate or severe cases, the symptoms can be present all the time, day and night. They can also come on with certain activities, such as holding a phone or reading a paper/electronic device.
The classic symptoms are:
- An ache or pain in your fingers, hand and sometimes arm
- Numbness in the hand
- Burning, tingling or pins and needles in the fingers – usually the thumb, index, middle and ring
- Weakness in the hand or difficulty gripping
Before
Your doctor will examine you by testing the feeling in your fingers and the strength of the muscles in your hand. Assessing the nerve by bending, tapping, or pressing on the wrist will help them make a diagnosis.
Your doctor may also recommend having a nerve conduction study, although this isn’t always needed. This is a test which measures the tiny electrical pulses produced in your nerves and muscles. It can be used to diagnose carpal tunnel as well as rule out other conditions.
Milder cases of CTS can be treated without surgery. Treatments include:
- Avoiding the activities that bring on the symptoms
- Wearing a wrist splint at night
- A corticosteroid injection. This is usually performed by your specialist doctor in the outpatient clinic. It takes a couple of minutes and can give good relief from symptoms. However, symptoms may come back with time, despite an initial positive response.
During
If your symptoms are getting worse and other treatments have not worked, you may need to consider carpal tunnel release surgery.
This is a simple operation which takes around 10-20 minutes and is usually done under local anaesthetic. This means your hand is numb and you’re awake for the procedure. Sometimes your surgeon will discuss having this operation with you asleep. The procedure is performed as a day-case, meaning you will come into the hospital and go home the same day.
Your surgeon will make a cut at the base of your palm near the wrist. They will then cut the tight strap (transverse carpal ligament), which forms the roof of the tunnel that is compressing your nerve. Your skin will be closed with stitches and a dressing and bulky bandage applied.
Once we’re happy you’re doing well, we will take you to your private room where you can start your recovery.
Once the anaesthetic wears off, you’ll be able to go home. You will need a friend or relative to collect you as you will not be able to drive after surgery.
After
Most patients are required to wear the bulky bandage for a few days to a week when they’re recovering. It’s a good idea to have some help around the house during this time, as the dressing will make daily tasks difficult. After that, a smaller dressing can be put on your wound. You should avoid heavy lifting and keep the wound dry for at least two weeks after the operation. It is not usually very painful, but you may need to take some over-the-counter painkillers for a few days.
You will have a check-in with your doctor around two weeks after surgery. During this appointment, your stitches will be removed and you will be given some light exercises to prevent finger stiffness. Our hospital has an excellent hand therapy service which can help you with wound care, hand physiotherapy exercises and scar massage.
It often takes a few weeks for the pins and needles sensation of CTS to settle down after the operation. Allow yourself up to three months before you get 100% back to normal activities although you may find it takes around six months and up to one year for the numbness and tenderness in your hand to fully settle.
If you have a desk job or a job that involves manual labour: be careful when using your hand for the first two weeks. Light everyday activities should be okay but no heavy lifting for two weeks after the surgery. You can return to work after 2-3 weeks.
Driving should be avoided for at least the first seven to ten days after surgery. Take advice from your doctor on return to driving and only do so when you feel you are safe.
People who play sports may need to avoid heavy exercises for the first ten days or so and avoid heavy lifting for longer. Take advice from your doctor.
Medically reviewed by Mr Alistair Hunter - MA MBBS MSc FRCS (Tr&Orth) FHEA Dip Hand Surg on 13/11/2023
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