Carpal Tunnel Syndrome

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What is Carpal Tunnel Syndrome (CTS)?

Carpal Tunnel Syndrome is sometimes associated with hormonal changes such as pregnancy or an underactive thyroid. In most cases no specific cause is known, but previous trauma or cysts may cause swelling of the tunnel which presses on the nerve.

Treatment for mild symptoms may be to use a splint or have a cortisone injection. If these do not work or the symptoms come back, surgery can be performed. This involves dividing the carpal ligament on the upper surface of the tunnel, to take the pressure off the nerve.

Carpal Tunnel Syndrome (CTS) is the name given to a group of symptoms which are caused by pressure on the median nerve. This nerve travels down the arm and supplies sensation to the thumb, the index, middle and half the ring finger. It also controls some movements of the thumb. At the wrist it travels through the carpal tunnel, which it shares with the tendons which bend the fingers. Typical symptoms are numbness, pins and needles and pain in the hand, which is often worse at night or with repetitive movements.

The position of the median nerve in the wrist
Part of the hand usually affected in CTS

Carpal Tunnel Decompression Surgery

In this video, Dr Jon Williams explains more about what carpal tunnel decompression surgery involves.

Before the operation

We will see you in a clinic to explain the operation in more detail and answer any questions. If you are happy to go ahead you will sign a consent form. We will then make arrangements for the operation (usually within 1 month). It is sometimes possible to have the operation on the same day as the outpatient appointment – please let us know beforehand and we will try to make a suitable arrangement.

Please let us know if you are taking any blood thinning drugs (such as aspirin, warfarin, clopidogrel) and if you have any allergies.

On the day

About the operation

You will be awake during the procedure. The surgeon gives you an injection into the hand to make it numb. They then make a cut in the palm about 2 inches long to reach the carpal ligament, which lies on top of the median nerve. The ligament is then divided to give the nerve more room.

The wound is closed with stitches and a large bandage is then applied. You will go home with your arm in a sling.  

A cross section of the carpal tunnel

After the operation

Expectations

The speed of recovery from carpal tunnel surgery can be markedly variable.  There are multiple factors for this and, in fact, it is unusual to have patients having the same recovery in both hands when they have had both hands operated on by the same surgeon.  The usual expectations would be for you to be able to only carry out light duties and non-repetitive tasks for the first 6 weeks after the operation.  You will continue to find some specific movements, particularly twisting movements of the wrist (eg. opening a stiff door handle), painful for approximately 3 months after the operation.  Most people report that they have some tenderness around the site of their wound when they press on this for at least 6 months after the operation.  It is not unusual for people to feel that they have not fully recovered from the operation for up to 9 months.

Equally, the nerve itself can take some time to recover.  It is said that this is largely dependent on how long you have had your carpal tunnel syndrome for and how severely compressed the nerve has been during that time.  If the nerve has been severely compressed, then it may not recover completely. Nerves take a long time to improve if they have been severely compressed and it is often the case that you cannot really tell what your recovery will be from your carpal tunnel surgery for the first year.  Your surgeon will be able to give you more accurate guidance on what to expect based on your individual circumstances and your medical history.

Risks

Stiffness

Some people get stiffness after the operation. Try to keep the hand and wrist moving as instructed above.

Swelling

The hand swells after the operation, so keep it elevated.  Slight swelling can last a few months.

Infection

This is uncommon after the operation, but if the wound becomes red and swollen you may need antibiotics.

Scarring

The scar may be sore and sensitive for a few months.  Sometimes the area around it becomes numb.  Massaging with hand cream is very effective until it has settled down.

Bleeding/bruising

This may occur as in any operation and if you have problems you should seek advice.

Complex Regional Pain Syndrome

Some people complain of marked pain, sensitivity and stiffness after hand surgery.  This needs treatment with painkillers and physiotherapy.

Nerve Damage

There is a possibility of damage to the nerves in the operation but this is rare.

Recurrence

This is uncommon but is known to occur.

Post-op exercises

After having surgery for Carpal Tunnel Syndrome (CTS), it's important to keep your fingers mobile. In this video, Dr Jon Williams demonstrates some exercises we recommend you do to help your recovery.

Useful websites

NHS website >Patient.info >
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