What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition that affects the hand, wrist and arm. Patients diagnosed with this syndrome often struggle with numbness, tingling and pain in the affected areas as a result of pressure on a nerve in the wrist, which can lead to compromised movement in day to day life.

What causes the condition?

Carpal tunnel syndrome is caused by a pressure on the median nerve (the nerve which runs up the arm) in your wrist. It is often repetitive motions that cause the syndrome, such as typing. If you suffer from conditions such as arthritis or diabetes, or if you are obese, you may be more likely to suffer with carpal tunnel syndrome.

Carpal tunnel syndrome symptoms often feel heightened in the morning, as your fingers “fall asleep” throughout the night; it depends on how your hands are positioned as you sleep.

Women are three times more likely than men to suffer from carpal tunnel syndrome, as women usually have smaller carpal tunnels. Pregnancy is often a cause of the syndrome too, although the symptoms usually ease after giving birth.

Some people may be more genetically predisposed to have the condition if a family member has been diagnosed with carpal tunnel syndrome. Certain jobs that involve repetitive movements could increase the chance of a carpal tunnel syndrome diagnosis, such as working on an assembly line, or as a cashier.

What are the typical signs?

Symptoms of carpal tunnel syndrome are centred around pain and numbness. Common signs include:

• An aching pain in your fingers, hands and arms
• A tingling feeling similar to pins and needles
• Numb hands, a weak thumb and difficulty gripping

How is it diagnosed and treated?

Diagnosis

If you struggle with any of the symptoms listed above and believe you may have carpal tunnel syndrome, seek advice from a specialist. Common routes to diagnosis for this condition include imaging tests such as X-rays, MRIs and ultrasounds, and an electromyogram, which involves a consultant putting a thin electrode into a muscle to measure its electrical activity.

Another method of diagnosing carpal tunnel syndrome is taping electrodes to the skin to measure the nerve signals of your hands and arm.

Non-surgical treatment:

Before surgical treatment for carpal tunnel syndrome is considered, there are several other options to explore. The treatment method chosen will depend on how far advanced the syndrome is within a patient. A nerve specialist may advise you to wear a wrist splint while you sleep, however, it can take around four weeks to notice an improvement. 

You will likely be advised to reduce movements that require maintaining a hard grip, such as playing an instrument. In the short term, over-the-counter painkillers and anti-inflammatories may help, although they don’t treat the underlying cause of carpal tunnel syndrome.

If these treatment methods are unsuccessful, you may be offered a steroid injection to reduce the swelling around the nerve, which can ease the symptoms. 

Surgery

A procedure called carpal tunnel release is often performed to ease the symptoms of carpal tunnel syndrome. It involves cutting the carpal ligament, which is connected to the wrist bones that form the carpal tunnel.

This surgery is offered to patients suffering from carpal syndrome more severely, to the point where it may be affecting their quality of life, and where non-surgical treatments have been unsuccessful.

If you are undergoing carpal tunnel release surgery, you will be treated as an outpatient, meaning that you will not have to stay in hospital overnight. Most commonly, patients will receive a local anaesthetic, so you will be awake, but the area being operated on will be numb.

Carpal tunnel release surgery can be performed via either “open” or “keyhole” surgery. Open surgery involves an incision being made near the bottom of your palm, and your carpal ligament being divided with a knife, which then lessens the strain on your median nerve. The skin will then be closed with stitches, before a bandage is applied to the hand.

Keyhole surgery consists of a doctor making one or two small incisions in your skin near the carpal tunnel. After this, a small camera is placed inside so that your hand and wrist can be viewed, and a cut can be made in your carpal tunnel. This type of surgery often results in less damage to the tunnel.

Recovery

Recovering from carpal tunnel release surgery is generally straightforward. Over-the-counter pain relief may be required to help ease the pain after the local anaesthetic has stopped taking effect.

Before being discharged from hospital, you will be advised on how to keep the wound on your hand clean. It is beneficial to gently wriggle your fingers to restore motion and reduce swelling and stiffness. Certain movements, such as touching the tip of your finger to your thumb in turn, can assist your hand’s recovery.

A bandage will aid the recovery of your hand, as well as keeping it supported. You will most likely be able to remove the bandage after two to three days, however you must ensure that the hand is dry until the stitches are removed (this usually happens around two weeks after surgery).

Most patients find that they are recovered within between six and twelve weeks, however some patients could find that it takes longer, up to three months.

When can I return to normal activities?

• Work – If your job is not physically demanding, it is probable that you will be able to return to work two weeks after undergoing surgery. This of course varies from person to person, and if your job involves more heavy exertion, you may not be able to return to work this soon. Your consultant will be able to advise you on these time frames.
• Driving – You should be able to drive again once you feel completely comfortable with performing an emergency stop, gripping and controlling the steering wheel and sitting comfortably in your car. If you are unsure whether it is safe for you to drive, please consult your specialist.
• Exercise – Very gentle hand exercises are encouraged after your surgery, to help with your hand’s mobility. Everyday activities such as getting dressed and typing will help to regain strength in your hand.

In terms of returning to heavier exercise, such as weight lifting or playing a sport, please ask your consultant about this.