CARPAL TUNNEL SYNDROME

Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.

Symptoms

Common symptoms of carpal tunnel syndrome include numbness and tingling sensation in all the fingers except little finger; pain and burning sensation in hand and wrist that may radiate up the arm and elbow; and weakness in hand with diminished grip strength.

Causes

Exact causes of the condition are not known. However certain factors increase the risk of developing carpal tunnel syndrome and they include congenital abnormalities, repetitive motion of hand and wrists, fractures and sprains, hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst, tumour or abnormal muscle in the canal. Rarely acute trauma such as a lunate (small bone of the wrist) dislocation or old trauma such as a malunited fracture of the lower end of the radius can cause secondary carpal tunnel syndrome.

Investigations

While the diagnosis of Carpal tunnel syndrome is mainly clinical, x-rays especially the carpal tunnel view is important to diagnose bony encroachment of the carpal tunnel. An Ultrasound can identify Median nerve atrophy/ soft tissue compression of the nerve by entities such as a ganglion, aberrant muscle or other SOL’s.

Conservative Treatment Options

Carpal tunnel syndrome may be treated using conservative approaches or surgery. The conservative treatments include:

  • Treating underlying medical conditions
  • Immobilisation of the hand and wrist with a splint or wrist brace for 4-6 weeks
  • Rest the hand 
  • Avoid activities that tend to worsen the symptoms
  • Medications such as non-steroidal anti-inflammatory drugs and steroid injections
  • Strengthening and stretching exercises once symptoms diminish

Surgery

If conservative treatment options fail to resolve the condition Dr Bala may recommend a surgical procedure.

Carpal Tunnel Release Surgery

Carpal tunnel syndrome can be treated with carpal tunnel release Surgery. During the surgery, the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. The covering around the tendons in the tunnel are also removed to decompress the tunnel. Dr Bala will decide which options are best for you based on your general and medical conditions.

Dr Bala believes that adequate decompression is difficult to achieve through keyhole surgery for this condition while addressing other conditions present in the carpal tunnel. Although he is trained to perform this keyhole, he also believes that the nerve is best visualized and freed in an open procedure. He prefers general anaesthesia over local anaesthesia for faster recovery and to better visualise important structures to protect. He may choose to do it under local anaesthesia or under WALANT (wide awake local anaesthesia no tourniquet) if medically indicated.

 

Post-Operative Care

Dr Bala may suggest you practice certain post-operative procedures for better recovery and to avoid further complications.

  • Elevate the hand above heart level to reduce swelling.
  • Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
  • Physiotherapy may be ordered to restore wrist strength.
  • Eating a healthy diet and not smoking will promote healing

Risks and Complications

Most patients suffer no complications following carpal tunnel release surgery. However, in rare cases a patient may suffer from pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.

Dr Bala uses special magnification loupes to visualize and protect these structures to minimize complications. In the event you may have a tattoo on the wrist or hand Dr Bala is well versed in suturing tattoos back accurately with absorbable sutures.