Signs and Symptoms
People generally describe numbness in their thumb, index, middle, and half of the ring finger. Sometimes this pain or ache does travel up the arm. Pain can occur in the wrist, and some people also describe weakness in their grip strength. This can lead to weakness holding some items, and can result in dropping items you would normally hold without any difficulty.
Most people describe being woken at night to a numb or tingling hand, and have to ‘shake out’ the numbness. This can also be associated with a burning, ache, or the sensation of ‘electrical shocks’.
If the compression progresses from mild to more severe, occasional numbness will become constant and weakness may lead to paralysis of some muscles of the hand. Perception of vibration, temperature and pressure are usually the last sensations to be lost.
There can be several causes for CTS. Compression of the nerve can be due:
- ganglion cyst or tumour
Some people are genetically predisposed to having carpal tunnel syndrome due to their anatomy at the wrist. Hence, multiple family members may develop carpal tunnel syndrome at a younger age.
CTS is usually diagnosed based on clinical findings, and confirmed with an electromyogram (EMG) or a nerve conduction study (NCS). If there is a concern that the CTS is secondary to a medical condition, blood tests may need to be performed.
Depending on the severity of symptoms and clinical findings, non-operative treatments can significantly improve symptoms. These include the use of:
- Steroid injections
- Activity modification
For those patients that fail conservative management, or present with advanced symptoms, surgical release of the transverse carpal ligament should relieve pressure on the median nerve, and the symptoms of a CTS.
A carpal tunnel release is performed as a day procedure (home on the same day), under light sedation or a general anaesthetic. It involves the use of a tourniquet, a small incision at the wrist that is approximately 1.5-2cm long.
Healing time is approximately 10-14 days, and return to light duties at work is around the same time. You will be given hand exercises that you should start from approximately day 2-3 post-operatively. This ensures that your hand doesn’t become stiff, and that your tendons glide, and avoid sticking together.
Returning to full duties is dependent on your hand mobility, residual pain, and severity of symptoms before the operation. You will see a hand therapist throughout your recovery, and a night time splint is sometimes used for up to 3 weeks.
It is not uncommon to have some residual day time numbness and tingling, for up to a few months after the operation. Night time pain and tingling usually resolves within days.
In some people, there is a residual ache in the wrist that can persist for up to a year after the operation. It is termed ‘pillar pain’, and is related to the healing and inflammation near the carpal bones.
There are risks involved with any procedure. The general risks, as with any procedure include the following:
Specific risks associated with a carpal tunnel release include the following:
- Loss, or change of sensation to the hand
- Persistant, weak grip strength
- Recurrance of symptoms
- Sensitive scar
- Complex Regional Pain Syndrome
Each patient has different anatomy, and specific expectations. Not everyone is a good candidate for carpal tunnel surgery. Discuss your particular circumstances with Dr Perron before deciding what is best for you.