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Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

It is entrapment of a nerve at the wrist, which supplies feeling to the thumb, index, middle and half of the ring finger and also the musclesnear the base of the thumb. It is more common in women than men and affects both hands in a high percentage of cases.

What are the usual symptoms?

The usual symptoms are:

Altered sensations including numbness, pins and needles, burning or deadness

A feeling of swelling and pain in the fingers and wrist, especially when waking up in the morning

Clumsiness when eating, writing, doing up buttons and similar tasks

It is usually worse at night and when lifting the hands up, such as when driving or reading a newspaper. In advanced cases the numbness, burning sensations and pain will disappear and be replaced by deadness with marked loss of dexterity as well as thinning of the muscle near the base of the thumb.

It is usually worse at night and when lifting the hands up, such as when driving or reading a newspaper. In advanced cases the numbness, burning sensations and pain will disappear and be replaced by deadness with marked loss of dexterity as well as thinning of the muscle near the base of the thumb.

What causes it?

In most cases the cause is unknown but in a small number of patients precipitating factors include pregnancy, the menopause, under-active thyroid, diabetes, obesity, rheumatoid arthritis and sleeping habits with the wrists bent.

How can I be sure that I suffer from carpal tunnel syndrome?

Added to your symptoms and the positive findings on clinical examination, a special test called nerve conduction studies can be performed by a neurophysiologist to confirm the diagnosis and the degree of severity. This is not required in all cases if the symptoms are typical.

What are the treatment options?

1. In the early stages and during pregnancy, wearing night splints tokeep the wrist straight can help. More often than not, the carpal tunnel syndrome symptoms in pregnancy settle after delivery.

2. Cortisone (steroid) injection can be used in the early stages if the symptoms are severe.

3. If the symptoms are severe or have been persistent for more than 3-6 months, surgical release is usually recommended.

What does the operation involve?

Carpal tunnel release consists of releasing the tight band across the nerve at the level of the wrist. This is usually done under a local anaesthetic and uses an incision about 3-4 cm in length. All jewellery, nail varnish and false nails must be removed from the hand that is to be operated upon. At the end of the procedure, the wound is stitched and a padded dressing applied.

Will I be able to use my hand after surgery?

The bandage on your hand will be reduced in size at 2-3 days. You should not wet your bandage but use your hand gently within the limits of your bandage avoiding pressure over the front of the wrist. The scar is over a sensitive area at the front of the wrist and you should avoid pressure over this area for 2 weeks and strenuous manual activities, such as gardening and DIY for up to 2 months. You will be able to drive a car after 5 to 10 days.

Can the operation do me any harm?

Wound tenderness and swelling: this may persist for several weeksafter surgery but will resolve.

Incomplete relief of symptoms: in some cases, damage to the nerve caused by the pressure remains after surgery, and some numbness, weakness and loss of dexterity may persist
In some advanced cases, especially in elderly people, surgical release can be followed by unpleasant sensations in the hand with burning or numbness even if the surgical release is successful because there is some return of the blood supply to the nerve. These symptoms can persist depending on the duration and the degree of compression prior to surgery.

Infection: rare and usually easily treated with antibiotics

Nerve injury: very rarely the nerve can be damaged during release
leaving some permanent symptoms.

The Manchester Orthopaedic Group has three hand and wrist surgeons. Steve Royle , Jochen Fischer and Mohammed Waseem are established consultants. They are able to offer a range of treatments for various conditions from carpal tunnel syndrome to wrist arthritis.

What is carpal tunnel syndrome?

It is entrapment of a nerve at the wrist, which supplies feeling to the thumb, index, middle and half of the ring finger and also the musclesnear the base of the thumb. It is more common in women than men and affects both hands in a high percentage of cases.

What are the usual symptoms?

The usual symptoms are:

Altered sensations including numbness, pins and needles, burning or deadness

A feeling of swelling and pain in the fingers and wrist, especially when waking up in the morning

Clumsiness when eating, writing, doing up buttons and similar tasks

It is usually worse at night and when lifting the hands up, such as when driving or reading a newspaper. In advanced cases the numbness, burning sensations and pain will disappear and be replaced by deadness with marked loss of dexterity as well as thinning of the muscle near the base of the thumb.

It is usually worse at night and when lifting the hands up, such as when driving or reading a newspaper. In advanced cases the numbness, burning sensations and pain will disappear and be replaced by deadness with marked loss of dexterity as well as thinning of the muscle near the base of the thumb.

What causes it?

In most cases the cause is unknown but in a small number of patients precipitating factors include pregnancy, the menopause, under-active thyroid, diabetes, obesity, rheumatoid arthritis and sleeping habits with the wrists bent.

How can I be sure that I suffer from carpal tunnel syndrome?

Added to your symptoms and the positive findings on clinical examination, a special test called nerve conduction studies can be performed by a neurophysiologist to confirm the diagnosis and the degree of severity. This is not required in all cases if the symptoms are typical.

What are the treatment options?

1. In the early stages and during pregnancy, wearing night splints tokeep the wrist straight can help. More often than not, the carpal tunnel syndrome symptoms in pregnancy settle after delivery.

2. Cortisone (steroid) injection can be used in the early stages if the symptoms are severe.

3. If the symptoms are severe or have been persistent for more than 3-6 months, surgical release is usually recommended.

What does the operation involve?

Carpal tunnel release consists of releasing the tight band across the nerve at the level of the wrist. This is usually done under a local anaesthetic and uses an incision about 3-4 cm in length. All jewellery, nail varnish and false nails must be removed from the hand that is to be operated upon. At the end of the procedure, the wound is stitched and a padded dressing applied.

Will I be able to use my hand after surgery?

The bandage on your hand will be reduced in size at 2-3 days. You should not wet your bandage but use your hand gently within the limits of your bandage avoiding pressure over the front of the wrist. The scar is over a sensitive area at the front of the wrist and you should avoid pressure over this area for 2 weeks and strenuous manual activities, such as gardening and DIY for up to 2 months. You will be able to drive a car after 5 to 10 days.

Can the operation do me any harm?

Wound tenderness and swelling: this may persist for several weeksafter surgery but will resolve.

Incomplete relief of symptoms: in some cases, damage to the nerve caused by the pressure remains after surgery, and some numbness, weakness and loss of dexterity may persist
In some advanced cases, especially in elderly people, surgical release can be followed by unpleasant sensations in the hand with burning or numbness even if the surgical release is successful because there is some return of the blood supply to the nerve. These symptoms can persist depending on the duration and the degree of compression prior to surgery.

Infection: rare and usually easily treated with antibiotics

Nerve injury: very rarely the nerve can be damaged during release
leaving some permanent symptoms.

The Manchester Orthopaedic Group has three hand and wrist surgeons. Steve Royle , Jochen Fischer and Mohammed Waseem are established consultants. They are able to offer a range of treatments for various conditions from carpal tunnel syndrome to wrist arthritis.


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