Carpal Tunnel Syndrome
If you have been diagnosed with Carpal Tunnel Syndrome (CTS), this accessible guide will help explain the condition, as well as its symptoms, causes, diagnosis, and the available treatment options.
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) occurs when increased pressure on the median nerve in the wrist leads to sensations of pins and needles, numbness, or even weakness in the hand.
The median nerve runs from the neck through the arm and wrist via the carpal tunnel—a narrow passage formed by the wrist bones and a ligament that acts as the tunnel’s roof. When this nerve is compressed, it causes CTS symptoms.
What causes CTS?
CTS can develop due to increased pressure within the carpal tunnel, though in many cases, there is no identifiable cause. Factors linked to CTS include:
- Diabetes
- Pregnancy
- Underactive thyroid (hypothyroidism)
- Arthritis or wrist fractures
- Repetitive or heavy hand activities
Early symptoms often appear at night, but as the condition progresses, they may occur more frequently and during the day.
How is CTS diagnosed?
Diagnosis combines several assessments:
- Patient history: Reviewing symptom patterns.
- Clinical tests: Performed by your GP, consultant, or therapist.
- Nerve conduction studies (NCS): These electrical tests measure nerve function and help confirm the diagnosis, assess its severity, and can help guide treatment plans.
How is CTS treated?
The treatment depends on symptom severity. Options include:
Splints
Wearing a splint, especially at night, keeps the wrist in a neutral position, reducing pressure on the median nerve. About one in three patients find this sufficient.
Steroid Injections
A local cortisone injection into the carpal tunnel can provide temporary pain relief. While most patients benefit, symptoms can return, and rare risks include infection or nerve damage.
Surgery
For severe or persistent cases, surgery may be required. This involves a small incision in the palm to release the ligament, relieving pressure on the median nerve.
- Procedure: Performed under local anaesthetic as a day case.
- Outcomes: Most patients experience permanent relief, though in severe cases, some nerve damage may remain.
What happens if I don’t have surgery?
Without treatment, symptoms may persist, worsen, or become permanent. Weakness in hand muscles may also develop, impacting daily activities.
Risks of Surgery
Surgical complications are uncommon but can include:
- Temporary scar tenderness or hand weakness
- Pain, particularly when gripping
- Wound infection (1 in 100 cases)
In rare cases, patients may develop Complex Regional Pain Syndrome (CRPS), a condition causing severe pain, swelling, and stiffness in the hand. If pain persists beyond four to six weeks post-surgery, contact your consultant.
Preparing for Surgery
Before surgery, you’ll have a pre-assessment appointment to discuss the procedure and address any concerns. Key points to remember:
- Remove all rings before the day of surgery.
- If you smoke, consider quitting to improve healing and reduce risks.
On the Day of Surgery
- Arrival: Follow instructions in your appointment letter. A team member will guide you upon arrival.
- Hospital Stay: The procedure is a day case, and you’ll typically stay for 3-4 hours.
After Surgery
Pain Management
Discomfort is normal and usually manageable with simple painkillers like paracetamol.
Driving and Work
- Driving: Resume when your hand feels comfortable. This is typically between 4-5 days to 1-2 weeks post-surgery.
- Work: Return depends on job type—light duties can be resumed after 1-2 weeks; more physically demanding roles may require longer.
Dressing and Wound Care
- Remove the bulky dressing after 48-72 hours, keeping the wound dressing clean and dry.
- Watch for signs of infection (e.g., excessive pain, swelling, tenderness) and seek medical advice if needed.
Stitches
Dissolvable stitches are typically used and will begin to come away after about two weeks.
Scar Care
To improve healing and reduce sensitivity, massage the scar with a water-based hand cream for up to eight weeks.
Rehabilitation
Keep your hand elevated for the first 48 hours to reduce swelling and stiffness. Perform simple hand exercises to maintain mobility.
Simple Hand Exercises
Begin these exercises on the day of your surgery:
1. Make a full fist and release.
2. Straighten your fingers fully.
3. Touch your thumb to each fingertip.
4. Spread your fingers wide and bring them together.
5. Reach your hand as high as possible.
Perform 5-10 repetitions of each exercise, 4 times daily, depending on comfort.
Follow-Up and Further Information
Routine follow-up appointments are not typically required. If you have concerns, contact your consultant.