Carpal Tunnel

Carpal tunnel syndrome is caused by a nerve in your wrist, called the median nerve, being compressed. The exact cause of this nerve compression is unknown but it is more likely to happen with certain factors that include:

• Being overweight or obese
• Wrist fracture or dislocation
• Doing repeated activities where your wrist is in an unnatural position, either very flexed or extended 
• The presence of a cyst or tumour in your carpal tunnel that presses on your nerve or narrows the tunnel
• Having a parent, brother, or sister with CTS
• Having a medical condition such as:
- joint or bone diseases including rheumatoid arthritis, gout, arthritis, and osteoarthritis
- diabetes
- hormonal changes of pregnancy, an underactive thyroid (hypothyroidism), or an overactive pituitary gland (hyperpituitarism).

The effects of carpal tunnel syndrome often start slowly and come and go. They tend to get worse at night.

Carpal tunnel syndrome symptoms include:

• Pain in your hand, finger, or arm 
• Numbness in your hand
• Tingly thumb and fingers
• Weak thumb
• Hand clumsiness, difficulty gripping, and a loss of your manual dexterity

CTS is a common problem, with individuals who perform strenuous and repetitive hand and wrist motions being more at risk. Carpal tunnel syndrome prevention methods may include:

• Keeping your wrists straight as much as possible, when working, sleeping, doing repetitive activities, and using tools. 
• Relaxing your grasp, reducing forceful pinching, and avoiding flexing and extending your wrists.
• Taking frequent breaks from repetitive activities.
• Performing stretching exercises before and after activities.
• Keeping your hands warm and flexible.

Carpal tunnel surgery is a wrist procedure that aims to relieve carpal tunnel syndrome symptoms such as hand pain, numbness, and tingling in your hand. Often patients get better sleep after CTS surgery as they no longer have these symptoms.

It can also increase your hand’s function so that you can use it fully again.

Your doctor usually diagnoses CTS by asking about your symptoms, your general health, and medical history and by checking your hand.

They may test for carpal tunnel syndrome by:
• Pressing down or tapping along your median nerve on the palm side of your wrist and hand to see if it causes tingling in your fingers (Tinel’s sign).
• Flexing and holding your wrists to see if you feel numbness or tingling in your hands (wrist flexion or Phalen test).
• Lightly touching your fingertips with a special instrument with your eyes closed to test their sensitivity.
• Checking for muscle weakness around the base of your thumb.
• Looking for smaller muscles (atrophy) around the base of your thumb. 

They may also refer you for tests, such as an electromyography (EMG) test to measure how well your median nerve is working and check the amount of pressure on it, an ultrasound scan to see if there are signs of compression on your median nerve, and an X-ray and MRI to exclude other causes.

You should treat CTS early. Conservative treatments are more likely to help if you have mild to moderate symptoms.

Initially, you can try to:
• Rest your hands more
• Avoid activities that worsen your symptoms 
• Apply cold packs to reduce swelling.

Nonsurgical treatments that your doctor may prescribe to help improve carpal tunnel syndrome, include:

• Wrist splinting – to hold your wrist still, usually at night to help relieve night-time tingling and numbness symptoms and also daytime symptoms. Splinting is often used if you are pregnant.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) - such as ibuprofen can offer short-term pain relief.
• Corticosteroids – may be injected into your carpal tunnel to relieve pain, inflammation, and swelling.

Your health care provider will determine the best treatment for you based on a number of things. These include your age, health and medical history, the symptoms of your CTS, and your tolerance and preferences for medications and procedures.

They may recommend non-surgical options if the syndrome is mild or surgery if you have tried other options and they are not giving you the symptom relief you need. 

If you decide to have surgery it can be performed by open or keyhole surgery. Keyhole surgery is often the preferred choice if possible as it offers fast outpatient treatment with a quicker and less painful recovery compared to open surgery. Ramsay’s hand and wrist surgeons are highly experienced in keyhole surgery. Your orthopaedic surgeon will discuss the most appropriate option for you.

Carpal tunnel release surgery, also known as carpal tunnel decompression, is one of the most common hand surgeries. It is typically an outpatient procedure performed in twenty minutes under local anaesthetic.

What happens during surgery will depend on the CTS surgery you have:

• Open surgery - a single cut approximately 5cm long is made in the front of your wrist at the base of your palm. The carpal ligament in your carpal tunnel is then cut to relieve the pressure on the median nerve in your wrist.
• Keyhole surgery – a smaller cut of about 2cm long is made in your forearm just above your wrist, or in your palm. Your hand and wrist surgeon will pass a thin, flexible telescope, called an endoscope through the incision to see inside your wrist. The carpal ligament is then cut using tiny instruments to relieve the pressure on your median nerve as it passes through your carpal tunnel passage.

If you have carpal tunnel syndrome and non-surgical treatments haven’t been successful then carpal tunnel surgery may be recommended. If there is a chance of permanent nerve damage from your carpal tunnel syndrome, then your hand and wrist surgeon will recommend surgery.

This procedure is usually performed on an outpatient basis so you will usually go home the same day of your surgery.

Initially, you start to use your hand for light tasks such as holding a glass. You gradually build up your tasks. Your grip should return to normal after six to twelve weeks following your procedure.

You can drive again when it’s safe to do so. This is when you can grip and control the steering wheel properly and perform an emergency stop.

Your consultant may advise you to wear a carpal tunnel splint to keep your wrist from moving around and to lessen pressure on your nerves. The carpal tunnel brace will allow your wrist to be straight and less pressure on your wrist.

When you return to work will depend on your job and its requirements.

It’s best to follow your surgeon’s advice regarding your recovery and timings.

A full recovery can take six to twelve weeks.

Most patients have no complications after carpal tunnel release surgery.

However, there are potential risks to all types of surgery including CTS surgery, such as infection, pain, scarring, and nerve and blood vessel damage.

Pillar pain is a complication related to CTS surgery. It is an aching pain and tenderness in the fleshy part at your thumb base and little finger. It is often temporary and resolves within months. Other complication risks of CTS surgery include the loss of grip strength and hand dexterity, incision tenderness, scar tissue development, and palmar cutaneous neuroma which is a benign post-surgery growth on your medium nerve that can give a burning pain sensation, numbness, and tingling.

The costs of your carpal tunnel syndrome surgery will depend on the exact surgery you have and your chosen Ramsay hospital. CTS surgery at Ramsay starts at £1900 for one wrist and includes unlimited aftercare.

If you decide to pay for your treatment, Ramsay offers an all-inclusive Total Care package, where a single one-off payment at a pre-agreed price, delivers direct access to all the treatment you need for complete reassurance. You can also spread the cost of your treatment with a 0% payment plan.

A carpal tunnel surgery may be covered by your medical insurance policy. We advise you to check directly with your insurance provider to discuss the costs involved and get written confirmation before commencing treatment.

Ramsay Health Care offers you rapid access to appointments to diagnose and treat carpal tunnel syndrome at a time and convenient hospital location that suits you.

Carpal tunnel surgery is performed by our experienced orthopaedic surgeons who are specialists in hands and wrists. As they regularly perform this surgery and are experts in their field, our patients typically have very good outcomes.

Your chosen hand and wrist surgeons will discuss non-surgical treatment as well as surgical treatment of CTS. If remedies such as painkillers, splints, and steroid injections don’t provide enough relief for your symptoms, then surgery is recommended.

Surgery for CTS is usually carried out in our outpatient clinics. It is a quick procedure, usually performed by keyhole surgery so that patients have minimal scars, less pain, and a faster recovery than open surgery.

We aim to offer you the local best care at one of our local hospitals for your carpal tunnel surgery treatment.