Carpal tunnel syndrome

Carpal tunnel syndrome is one of the commonest reasons why patients seek the advice of a hand surgeon. It occurs when the median nerve is squashed under a thick ligament in the palm. The ligaments tends to get thicker with age which is why carpal tunnel syndrome is more common as people get older. It causes pins and needles and pain in the hand, often in the thumb, index and middle fingers because the nerve supplies these areas. If left untreated it can progress to permanent sensory disturbance, and permanent loss of the muscle at the base of the thumb. This muscle is important to move the thumb away from the fingers, which allows pinch; so untreated carpal tunnel syndrome can cause loss of pinch ability.

Mr Wharton often uses nerve conduction studies to confirm the diagnosis of carpal tunnel syndrome, and to assess its severity. To do this test a neurophysiologist places electrodes over the nerve, and uses electricity to stimulate the nerve causing the muscles to jump. Although it’s not a painful test it can feel very strange for a few seconds.

In the early stages Mr Wharton recommends sleeping with a wrist splint that has been bent into a straight position. This is because the pressures in the carpal tunnel have been shown to be lowest when the wrist is in a neutral position. For mild carpal tunnel syndrome, or where the diagnosis isn’t straight forward, Mr Wharton often recommends a steroid injection which he delivers in the clinic. Especially in younger patients steroid injections can take away the symptoms of carpal tunnel syndrome for many years.

If the condition is too far progressed Mr Wharton may recommend mini-open surgery to release the ligament. This surgery is done with the patient awake, using local anaesthetic to numb the skin in the palm. The thick compressive ligament is divided and the nerve is freed up in the hand and in the forearm. The skin is repaired, usually with dissolving sutures. The procedure usually takes around ten minutes, and patients go home the same day. Afterwards it is important to elevate your hand for at least five days, and keep the wound dry for two weeks.