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Carpal tunnel syndrome (CTS) is a condition where the median nerve is compressed where it passes through a short tunnel at the wrist. The tunnel contains the tendons that bend the fingers and thumb, as well as the nerve. CTS can occur with pregnancy, diabetes, thyroid problems, rheumatoid arthritis and other less common conditions, but most sufferers have none of these. CTS may be associated with swelling in the tunnel which may be caused by inflammation of the tendons, a fracture of the wrist, wrist arthritis and other less common conditions. In most cases, the cause is not identifiable.

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Symptoms.

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The main symptom is altered feeling in the hand, affecting the thumb index, middle and ring fingers; it is unusual for the little finger to be involved. Many people describe the altered feeling as tingling. Tingling is often worse at night or first thing in the morning. It may be provoked by activities that involve gripping an object, for example a mobile telephone or newspaper, especially if the hand is elevated. In the early stages the symptoms of tingling intermittent and sensation will return to normal. If the condition worsens, the altered feeling may become continuous, with numbness in the fingers and thumb together with weakness and wasting of the muscles at the base of the thumb. Sufferers often described a feeling of clumsiness and drop objects easily. CTS may be associated with pain in the wrist and forearm.

Nerve conduction tests may be needed to confirm the diagnosis. Blood tests and x-rays are sometimes required.

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Risk factors 

•     female sex 

•     obesity 

•     pregnancy 

•     hypothyroidism 

•     rheumatoid arthritis 

•     advanced age 

•     chronic renal failure 

•     smoking 

•     alcoholism 

•     repetitive motion activities 

•     mucopolysaccharidosis 

•     mucolipidosis 

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• • Associated conditions 

    •     diabetes mellitus 

    •     hypothyroidism 

    •     rheumatoid arthritis 

    •     pregnancy 

    •     amyloidosis 

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Treatment.

Non-surgical treatment.

It includes splints and steroid injection into the carpal tunnel. 

Depending on the duration and severity of symptoms, we will discuss, during the initial consultation, whether we should start treatment with a course of  steroid injections  or proceed straight to surgery.

 

The operation.

It is performed under local anaesthetic and it takes normally 20 minutes, during which you will be fully awake but won’t feel any pain. If you are an anxious person, we can discuss the option of a general anaesthetic.

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Surgery involves opening the roof of the tunnel to reduce the pressure on the nerve (see diagram). The scar will b n the palmar side of your wrist and usually becomes invisible after 3 - 6 months. I am  going to describe in detail the most frequent complications during the consenting procedure, well before the date scheduled for surgery.

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The outcome is usually a satisfactory resolution of the symptoms but the period of time required to settle down is very variable.

Night pain and tingling usually disappear within a few days. In severe cases, improvement of constant numbness and muscle weakness may be slow or incomplete. It generally takes about three months to regain full strength and a fully comfortable scar.

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Artwork: ©Donald Sammut 2017