Carpal Tunnel Syndrome - Harley Clinic

Carpal tunnel begins with tingling and numbness in the fingers, which most people initially dismiss as nothing. Some cases of carpal tunnel syndrome come and go in the early stages. If the disease progresses, the symptoms can intensify, making it difficult to sleep. In more advanced stages, most people have difficulty gripping things.

Carpal Tunnel Syndrome Surgery Overview

What is Carpal Tunnel Syndrome?

Carpal tunnel is a condition that develops when the median nerve becomes irritated and inflamed. The median nerve is a nerve that goes through the carpal tunnel, located in the wrist. Naturally, the carpal tunnel is narrow, and obstruction could affect the functioning of the fingers and hand. When the median nerve gets inflamed, it causes tingling and numbness in the ring, index and middle fingers.

The tingling and numbness may occur in one or both hands. If it affects both hands, you may feel pain and numbness in both hands or fingers simultaneously; a condition called bilateral carpal tunnel syndrome.

One of the significant causes of inflammation in the median nerve is too much pressure due to repetitive movements and use. Carpal tunnel is recognised as a work-related injury that can affect anyone working in manual labour or office.

What Causes Carpal Tunnel Syndrome?

As mentioned, the leading cause of carpal tunnel syndrome is repetitive use of the wrists resulting in too much pressure on the median nerve. The exact causes of carpal tunnel syndrome are unknown, but certain factors lead to median nerve inflammation. They include:

The anatomy of the hand: A wrist detachment or arthritis can change the shape of the small bone found in the wrist, narrowing the carpal tunnel and putting pressure on the median nerve.
Occupation factors: Some occupations are more likely to leave you at risk of carpal tunnel than others like bakers, carpenters, and heavy-keyboard users are more at risk than others.
Nerve damage: Conditions like diabetes can cause significant nerve damage, including damage to the median nerve, leaving you at risk of carpal tunnel syndrome.
Inflammatory conditions: Rheumatoid arthritis can lead to median nerve inflammation.
Underlying conditions: Some conditions like hypothyroidism, obesity, gout and amyloidosis are associated with carpal tunnel.
Tumours: Ganglion cysts and lipoma result in tumours that can protrude onto the carpal tunnel.
Other causes include trauma to the wrist, pregnancy and gender, where women are more likely to develop the condition.

What are the Symptoms of Carpal Tunnel Syndrome?

There are many carpal tunnel syndrome symptoms, but the main ones include:

Numbness, pain, tingling, or a burning sensation concentrated on the thumb, middle, index or ring fingers.
Occasional shock sensations radiating to the index, thumb, middle, and ring fingers.
As the disease advanced, the pain and tingling might travel to the forearm and shoulder.
In more advanced cases, you may experience weakness and clumsiness, making it difficult to perform basic tasks like buttoning your shirt or holding your phone.

The weakness and numbness eventually lead to loss of proprioception, where one loses awareness of where their hand is in space.

The symptoms of carpal tunnel syndromes, in most cases, begin gradually without any specific cause. Most patients’ symptoms come and go, so they don’t always seek treatment. Many go for carpal tunnel syndrome treatment when the condition has worsened because the symptoms occur too frequently or persist for too long.

Symptoms of carpal tunnel are common at night since many people sleep with their wrists bent. Your doctor will talk to you about how to sleep with carpal tunnel syndrome.

Before going for a carpal tunnel syndrome test, you must remember that the disease is often misdiagnosed. Two conditions that are often misdiagnosed as carpal tunnel syndrome are arthritis and wrist tendonitis.

What are the Best Carpal Tunnel Syndrome Treatments?

Treatment for carpal tunnel should begin as soon as symptoms appear. While the symptoms come and go in the early stages, it’s always a good idea to go to the hospital to rule out carpal tunnel and other conditions that share similar symptoms. Since the disease can result from underlying conditions like diabetes or arthritis, it’s important to speak with your doctor.

Although the disease progresses gradually, most people’s symptoms worsen over time without treatment. In the early stages, it’s possible to slow down and even stop the progression of the disease. Treatment may involve both surgical and non-surgical interventions.

What Does Non-Surgical Treatment for Carpal Tunnel Involve?

If you’re diagnosed with carpal tunnel syndrome early, you may not need surgery. The doctor may suggest alternative treatment options like:

Wrist splint for carpal tunnel syndrome: Wearing a splint or brace is one of the most common treatments for carpal tunnel syndrome since it keeps your wrist from bending when asleep.
Nonsteroidal anti-inflammatory drugs: NSAIDs like ibuprofen help relieve inflammation and pain on the wrist.
Changing activities: If your symptoms occur when the hand and wrist stay in the same position for long, like when working, modifying the activities may help relieve the symptoms.
Nerve gliding exercises: Some people may benefit from nerve gliding exercises since the median nerve can move freely within the carpal tunnel.
Steroids: Cortisone and corticosteroid may be injected into the carpal tunnel to relieve pain and other symptoms.

What Happens During Carpal Tunnel Syndrome Surgery?

If non-surgical treatment doesn’t work, your doctor may recommend a carpal tunnel syndrome operation. The surgery often referred to as carpal tunnel release, involves one or more surgical techniques to relieve pressure on the median nerve. The doctor cuts the ligaments that form the root of the carpal tunnel, increasing the tunnel’s size and reducing pressure on the median nerve.

It is an outpatient procedure performed under local or general anaesthesia. Often, the surgeon will choose between open or endoscopic carpal tunnel surgery.

Open carpal tunnel release: The surgery involves making a small incision in the palm. The surgeon will then divide the transverse carpal ligament, which lies at the roof of the carpal tunnel, to increase its size and relieve pressure. After the surgery, the ligaments grow back longer, creating more space within the carpal tunnel.
Endoscopic carpal tunnel release: The surgeon makes one or two incisions and inserts an endoscope or miniature camera through the incisions to see the inside of your wrist. They will then use a special knife to divide the transverse carpal ligament, just like in open carpal tunnel release.

Both surgeries have the same outcomes. Before going in, your doctor will talk to you about the procedure, the potential risks, and advice on which option is best for you.

Recovery from Carpal Tunnel Release Surgery

The carpal tunnel syndrome surgery recovery time varies from one person to another. After the surgery, your doctor will advise you to keep your hand elevated and move the fingers to prevent stiffness and reduce swelling.

Following the surgery, you may experience some pain, stiffness and swelling, plus some minor soreness in the palm, which can last for a week to several months. For most patients, the nighttime symptoms improve almost immediately following the procedure.

Expect your grip and pinch strength to return 2 to 3 months after the procedure and 6 to 12 months if the disease has progressed past the initial stages. In very severe cases, your usual grip and strength may never return. However, surgery will help prevent the disease from progressing and causing permanent damage.

As for the tingling and numbness, expect that to improve a few months after the surgery. In mild cases, the sensation in the fingers will return immediately after the surgery, but in severe cases, the normal sensation will return 6 to 12 months after the surgery. As you can see, your recovery and improvement time after surgery depends on the severity of your symptoms.

You will have to wear a wrist brace or splint for the first few weeks after the procedure. You may also return to light activities like self-care, light lifting, and even driving soon after the surgery. Your doctor will advise on when you can return to work and if there are any adjustments you need to make to your workstation.

Potential Risks, Side Effects and Complications of Carpal Tunnel Syndrome Surgery

Risks and potential complications of carpal tunnel syndrome include:

Bleeding
Infection
Bruising
Swelling
Stiffness
Injury to the median nerve or surrounding nerves
Scarring
Loss of sensation

What Will Happen if Carpal Tunnel Syndrome is Not Treated?

If the disease progress, it could result in permanent nerve damage. If carpal tunnel syndrome is left untreated, it could lead to a loss of arm coordination and weakness before resulting in permanent nerve damage.

Consider seeing an orthopaedic doctor as soon as the symptoms begin disrupting your routine. Beginning treatments early will prevent more permanent damage.

Carpel Tunnel Release Surgery at The Harley Clinic

Book an appointment today at the Harley Clinic to discuss carpal tunnel syndrome treatment and understand your available options in more detail.

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