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Carpal Tunnel Treatment

Carpal Tunnel Syndrome is a painful condition that occurs when the median nerve is compressed at the level of the wrist.  The nerve and tendons that bend the fingers pass from the forearm into the hand through a narrow tunnel called the carpal tunnel.  When there is a build up of pressure in this tunnel the nerve becomes squashed and causes symptoms of carpal tunnel syndrome.

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Causes

The median nerve provides feeling and movement to the “thumb side” of the hand (the palm, thumb, index finger, middle finger, and thumb side of the ring finger). The tunnel is normally narrow so any swelling can pinch the nerve and cause pain, numbness, tingling or weakness.
Carpal tunnel syndrome occurs most often in people 30-60 years old, and is more common in women than men.

Factors that might lead to this syndrome include:

• Alcohol abuse
• Bone fractures and arthritis of the wrist
• Cyst or tumor that grows in the wrist
• Infections
• Obesity
• If your body keeps extra fluids during pregnancy or menopause

Symptoms

Pins and needles in the thumb, index and middle fingers.  This commonly occurs at night and the patient is often awakened from sleep and has to shake their hands to gain relief from these symptoms.  Occasionally in severe cases, the muscles on the front of the palm next to the thumb can waste, causing hollowing.  In such severe cases the thumb may become weak or clumsy.

Diagnosis

Modified Phalen's test - Direct pressure over the carpal tunnel especially whilst bending the wrist forward, may reproduce the pins and needles in the thumb, index and middle fingers. Tinel's test - Tapping the nerve in the carpal tunnel may cause tingling in these fingers.
Nerve conduction studies can be used to record the speed of the nerve across the wrist joint.  This can be compared to the other hand, or in cases where both hands are affected, compared to the normal population. The test takes about 20 minutes and is slightly uncomfortable. The majority of these tests are not required as specialists can normally tell from experience whether you have this condition or not.

Surgical treatment

Most people who have carpal tunnel syndrome have surgery.  The surgery is a day case procedure usually under local anesthetic and takes about 10 minutes.  A tourniquet is used; which is like a blood pressure cuff around the upper arm that prevents blood from obscurng the surgeons view.  It is quite tight, but well tolerated for up to 20 minutes.

The surgery will be performed through a 4cm incision.

Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 4 cm in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. This structure needs to be released to allow the contents of the carpal tunnel to be decompressed.

Having released this ligament the contents of the carpal tunnel are inspected to ensure adequate release and no other conditions are present.  The skin is sutured (stitched) with fine sutures and a bulky dressing is applied.  If you are interested, as there is no bleeding, it is possible for your consultant to show you the sight of compression once the nerve is released. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.

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Post surgery rehabilitation

You can go home soon after the operation.  The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The hand should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling.  Gently bend and straighten the fingers from day 1. The wound is cleaned and redressed with a simple dressing.  Avoid forced gripping or lifting heavy objects for 2-3 weeks. The sutures are removed at about 10 days. You should notice an improvement in symptoms within a week but the final result may be realised at about 3 months.

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