What is carpal tunnel syndrome?

Most of the tendons and one of the major nerves passing from the forearm and entering into the hand traverse a channel bounded behind by the wrist bones and roofed in by a strong and firm fibrous band. This is known as the carpal tunnel. In this confined space, the large median nerve is vulnerable to compression should any of the other structures swell. This gives rise to ‘carpal tunnel syndrome’.

The symptoms consist of tingling and numbness in the thumb and fingers, usually sparing the little finger. In severe cases, patients may find that their hand becomes clumsy and weak. In the worst cases, the muscles in the thumb base waste away, and the tingling or numbness become continuous.

Many conditions such as diabetes, pregnancy, thyroid problems and rheumatoid arthritis can predispose patients to this condition but in most cases, there is no such cause.

What treatment is available?

Carpal tunnel syndrome may respond to splinting, especially if it is only a problem at night. Steroid injections performed in the clinic may settle the problem, but many patients require surgery. The operation known as Carpal Tunnel Decompression is generally performed under local anaesthetic. A cut is made in the palm of the hand, and the tight fibrous band or ligament is divided. The surgery is generally straightforward, although in severe cases the recovery can be incomplete. If the nerve has been severely crushed for a long period of time, then sensation and muscle function may not fully return. Patients usually return to light duties after about two weeks, although it takes about three months to return to full normal pain-free activities such as heavy lifting.