Consultant Plastic and Reconstructive Surgeon
Consultant Plastic and Reconstructive Surgeon
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 commonly affects women in middle age but can occur at any age in either sex. 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.
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. 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.
In some cases, nerve conduction tests are needed to confirm the diagnosis. Blood tests and x-rays are sometimes required.
Non-surgical treatments include the use of splints, especially at night, and steroid injection into the carpal tunnel. CTS occurring in pregnancy often resolves after the baby is born.
Surgery is frequently required. The operation involves opening the roof of the tunnel to reduce the pressure on the nerve. The surgery may be performed under local anesthesia, regional anesthesia (injected at the shoulder to numb the entire arm) or general anesthesia.
The outcome is usually a satisfactory resolution of the symptoms. 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.
Surgery may be performed for severe cases of carpal tunnel syndrome. Many cases of carpal tunnel can be handled at home. Home care for carpal tunnel syndrome is straightforward and can often provide relief for mild cases of carpal tunnel syndrome. Many sufferers find relief by wearing a wrist splint which keeps the wrist in a neutral position at rest. Splinting is usually tried for a period of four to six weeks. Some people wear their splints at night only and others wear their splints both day and night, depending upon when the symptoms are at their worst.
Carpal tunnel syndrome affects the thumb, index, and middle fingers and is often particularly troublesome at night.
The diagnosis of carpal tunnel syndrome is based on the symptoms and the distribution of hand numbness. The wrist can also be examined for swelling, warmth, tenderness, deformity, and discoloration by visual examination by a plastic surgeon. The diagnosis is strongly suggested when a nerve conduction velocity (NCV) test is abnormal. A test of muscles of the extremity, electromyogram (EMG), is sometimes performed to exclude or detect other conditions that might mimic carpal tunnel syndrome.
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