Carpal tunnel syndrome surgery

Many people have heard of carpal tunnel syndrome but very few know exactly what it is and how to know whether you have it.

The carpal tunnel is the name given to a space within your wrist which contains tendons and the median nerve, one of the major nerves in the forearm. Should anything cause an increase in the pressure within the carpal tunnel, the median nerve may become compressed or irritated. This can cause numbness or tingling in the hand of varying degrees, depending on the extent of the injury to the nerve. This change in/loss of sensation is known as carpal tunnel syndrome.

Carpal tunnel syndrome can occur at any age and for a number of reasons, including:

  • Pregnancy,
  • Obesity,
  • Degenerative changes to the joint,
  • Wrist fractures or trauma,
  • Rheumatoid arthritis.

The most common symptoms are a tingling or numbness in the hand, and these can be more pronounced at night. Some people will choose to seek medical advice as soon as they start experiencing these symptoms while others will put up with their symptoms until they become more severe to ignore.

Before coming to see me, I find that people have often visited their GP first to get some advice. A GP can help, certainly when symptoms are reasonably mild, and they may arrange non-surgical treatments such as splinting of the hand and wrist or a cortisone injection to hopefully relieve the symptoms.

When I first see somebody, I will want to know about the feeling in their hand and fingers; in particular whether there is difference in the sensation between their various fingers and between the two hands.

One of the particular challenges in diagnosing carpal tunnel syndrome is that the symptoms can come and go; some days may be symptom-free while others can be really challenging. This means that sometimes when I see a patient, they may not have any symptoms at that exact time, although it is possible to ‘trigger’ the symptoms with certain clinical maneuvers that irritate or constrict the nerve, such as tapping on the nerve or moving the wrist into a flexed position.   

Where the symptoms are more severe, I would expect to see more established numbness or tingling, either across the entire hand or only in certain fingers.

As mentioned above, a GP can be very helpful in arranging conservative (non-surgical) treatments such as splints or cortisone injections. I frequently advise patients with mild symptoms to try these options first. There may be benefits in having the injections done by a specialist rather than your family doctor. The anatomy around the wrist can be pretty confusing and the danger of hitting an important structure inadvertently with the tip of the needle is real.

For people suffering with more severe symptoms, I would discuss the possibility of surgery to ‘release’ the trapped nerve in the carpal tunnel. This surgery can help prevent any further deterioration of the symptoms.

Carpal tunnel syndrome surgery also known as carpal tunnel release (CTR) relieves the pressure upon the median nerve in order to restore normal feeling in the hand.

CTR is normally done under a local anesthetic and only takes around 20 minutes. Once the surgery has finished, you will be able to go home very quickly. It will normally take around 4-6 hours for the anesthetic to wear off. This gives you time to take some pain killers.

You will have a well-padded dressing on to help cover and protect your hand and wrist and this will need to be changed after about a week. This dressing change can be done locally at your GPs or here in Circle if you prefer.

One thing I always tell people to expect is for their palm to be slightly tender for at least 4 weeks. You’ll be more aware of this when gripping or pushing with your hand. Depending on your job, you may need to take some time off work in order to avoid irritating the nerve again before you have fully recovered.

A session of hand physiotherapy can be helpful after this surgery, and that’s something I can arrange for you to have at Circle if you choose. I will then see you again in clinic between 4-6 weeks to review your healing and to talk with you about how your symptoms are to ensure everything is healing nicely.

As a Consultant Hand and Wrist Surgeon, I talk with people struggling with hand and wrist problems every day. I hear about their challenges and frustrations, as well as their hopes for effective treatment to get them out of pain and to relieve their symptoms.

Carpal tunnel syndrome can be debilitating to live with, but effective and straightforward treatment which causes minimal or no disruption to your daily life is available. It would be a real pleasure to help you. It’s easy to arrange a consultation with me at Circle; just contact my private secretary to book a time that is most convenient for you.

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020 3613 6779

Circle Reading Hospital, 100 Drake Way, Reading, RG2 0NE

Good

Overall rating 24th October 2019