Carpal Tunnel Syndrome (CTS)

The carpal tunnel is a relatively small space in the wrist through which 9 tendons and the median nerve pass into the hand. The median nerve supplies some muscles that work the thumb, and sensation to the thumb, index, middle and ring fingers. CTS occurs due to pressure on the median nerve in the carpal tunnel at the wrist.

Symptoms

Symptoms of CTS are typically pain in the hand and forearm, and tingling or numbness in the hand and fingers. The fingers may feel swollen and there may be weakness or clumsiness in the use of the hand. The symptoms are often worse at night and may be relieved by shaking or dangling the hand out of the bed.

Treatment

CTS is usually managed by non-surgical means initially. This may give significant or complete relief, meaning surgery is not necessary. Non-surgical treatments include:

  • Treatment of the underlying cause
  • Activity modification
  • Weight loss and exercise
  • Splint – usually at night
  • Steroid injection

If symptoms persist and non-surgical means are not effective, then surgery is usually considered. At surgery, the transverse carpal ligament is divided. This is the ‘roof’ of the carpal tunnel and division of it creates more space, thus relieving pressure on the median nerve (carpal tunnel release CTR).

The ligament can be cut by either open or endoscopic CTR. Results are generally the same with both procedures 6 months after surgery but recovery is quicker with the endoscopic technique. CTR can be performed under general or local anaesthetic and is performed as day surgery.

Recovery

The dressing is kept in place for 7-10 days post surgery. And patients can use their hands for gentle activities in the few weeks post surgery. The wound usually heals quickly and symptoms for CTS are often relieved within these first few weeks. However, any altered sensation can take many months to recover if it was present night and day prior surgery. Loss of muscle bulk at the base of the thumb may never recover.

More Information on Carpal Tunnel Syndrome

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Hand Carpal Tunnel Syndrome