Carpal Tunnel Syndrome

Symptoms often start gradually with numbness or tingling in your thumb, index or middle fingers that may come and go. Sometimes you may experience a sensation like an electric shock in these fingers. The symptoms may worsen when you hold something like a phone or steering wheel and they may disturb your sleep. Your hand may feel weak or clumsy due to numbness or loss of strength in the thumb’s pinching muscles which are controlled by the median nerve.

You should see an orthopaedic consultant if you suspect carpal tunnel syndrome as you can suffer permanent muscle and nerve damage if the condition goes untreated. The consultant will carry out a physical examination, assessing the feeling in your fingers and the strength of your hand muscles. An X-ray may be used to exclude other causes of pain, such as a fracture or arthritis. An electromyogram may be used to assess muscle damage. This involves inserting a thin needle electrode into specific muscles to assess electrical activity when the muscles contract and rest. You may also be sent for nerve conduction studies where small shocks may be passed through the median nerve to determine if the electrical impulses are slowed in the carpal tunnel.

It is important to take frequent breaks to rest your hand and wrist. Ice packs and anti-inflammatories can be used to reduce the swelling and wearing a wrist splint at night can help relieve night-time tingling and numbness. An injection of corticosteroids into the carpal tunnel may help to relieve pain and reduce inflammation. If the condition is linked to another health problems such as arthritis, your consultant will discuss treatment options.

Depending on the severity of your carpal tunnel syndrome, you may be offered surgery to relieve pressure by cutting the ligament that is pressing on the median nerve. Surgical options include:

• Endoscopic surgery – Small incisions are made in the hand or wrist and a device called an endoscope (a tube-like instrument with a tiny camera at one end) is passed inside to allow the surgeon to see inside the carpal tunnel so that accurate cuts can be made to the ligament.
• Open surgery – An incision is made in the palm of your hand over the carpal tunnel. Cuts are made through the ligament to free the nerve.

It can take three to four months to recover from carpal tunnel surgery and up to a year before your hand is back to full strength. Your return to work depends on the type of surgery you had, whether the surgery was on your dominant hand (the hand you use most), and your work. Your consultant will be able to advise you based on your particular situation.