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Carpal Tunnel Syndrome
WHAT IS CARPAL TUNNEL SYNDROME?
Carpal Tunnel Syndrome is a disease of the hand characterised by pain,
tingling, numbness and weakness. This disease most commonly affects
the middle and index fingers and the thumb and symptoms are usually
most problematic at night.
This condition typically develops in patients
with abnormally high pressure in the carpal tunnel, which in turn causes
compression of the median nerve. The median nerve travels down the arm
and enters the hand through the carpal tunnel, which is situated in the
central part of the wrist.
This condition develops in around 5% of the
population. The exact reasons for its development are unclear although
the following risk factors are associated:-
• Occupations involving repetitive wrist flexion and extension
• Pregnancy
• Rheumatoid Arthritis
• Diabetes
• Hypothyroidism
• Wrist Fracture
• Alcoholism
HOW IS CARPAL TUNNEL SYNDROME TREATED?
Although Carpal Tunnel Syndrome is rarely an emergency, it has been
proven that the earlier patients seek treatment the more likely this
condition is to respond to non-surgical intervention. If Carpal Tunnel
Syndrome is left untreated for a long time it is possible that irreversible
damage to the median nerve and related weakness and numbness will
occur. The first line of treatment for a patient experiencing mild symptoms
will be to enforce rest on the affected limb and to apply a support brace to
the wrist to restrict movement and reduce nerve irritation.
More serious
cases or those that fail to respond to enforced rest will require Carpal
Tunnel Release surgery, which is aimed at taking the pressure off the
median nerve.
HOW IS A CARPAL TUNNEL RELEASE PROCEDURE CARRIED OUT?
A Carpal Tunnel Release can be performed under General Anaesthetic
(you will be asleep) or Regional Anaesthetic (you will be awake). The
procedure usually takes only a short amount of time to perform
(approximately 30 minutes). Most procedures are provided on a Day-Case
basis.
During a traditional Carpal Tunnel Release procedure the Consultant
Orthopaedic Surgeon will make a small incision (cut) over the palm side
of the wrist and then release the ligament that covers the carpal tunnel.
By releasing this ligament the carpal tunnel increases and pressure is
relieved on the median nerve.
Minimally Invasive Surgical (MIS) procedures
are also becoming increasingly popular techniques performed by specialist
Hand Surgeons to correct this condition.
MIS is also known as 'keyhole
surgery" and provides a surgeon with a quick, easy and clear view of the
inside of the carpal tunnel through a pencil slim, high-resolution camera
known as an Arthroscope. The camera also includes a light source, which
allows the image picked up through the camera lens to be projected onto
a television monitor. The Consultant Orthopaedic Surgeon can then view
the carpal tunnel in an enlarged format and with the aid of clear vision via
the camera lens guide his fine instruments through another key hole
incision and release the ligament without a need to fully open up the wrist.
At the end of either procedure the wound or keyhole incisions are closed
with absorbable stitches or a simple sticky dressing
WHAT IS THE RECOVERY AFTER SURGERY LIKE?
Once a patient is fully recovered from the effects of anaesthetic they are
normally quickly encouraged to be as active and mobile as possible to
avoid complications such as joint stiffness and Deep Vein Thrombosis
from developing. It is therefore normal for patients to be encouraged to
undertake upper limb physiotherapy exercise just a few hours after surgery.
Following a progressive improvement of mobility and pain control, patients
are normally discharged home four to six hours after their surgery.
The
relief of symptoms can be immediate or progressively noticed over a period
of weeks. During the next six weeks patients will be expected to work on
improving their joint and hands mobility and range of movement through
dedicated and progressive physiotherapy. Your Consultant Orthopaedic
Surgeon will then assess your condition and range of movement after one
week and then again after six weeks to evaluate how successful the
release procedure has been.
Patients who are in employment should not
resume work until after their first consultation and dependant on the
physical nature of their job may be advised to take longer off work. Patients
should expect a continuous and full physical recovery to take from six to
twelve weeks to achieve.
ARE THERE ANY RISKS ASSOCIATED WITH CARPAL TUNNEL RELEASE SURGERY?
Although Carpal Tunnel Release surgery is very regularly performed
without any complications occurring, it is very important that all candidates
are fully aware of both the benefits and risks of undertaking specialist
surgery of this kind. All surgery, no matter how expertly or carefully it is
performed, carries risks and the importance of a full evaluation and
consultation to discuss your condition in relation to these risks cannot be
over emphasised.
HOW DO I FIND OUT IF I AM A SUITABLE CANDIDATE FOR CARPAL TUNNEL RELEASE?
At NW Specialist Clinic our Consultant Orthopaedic Surgeons will carry
out a full evaluation of your individual needs and circumstances, provide
you with a comprehensive verbal and written explanation of your condition
and recommend the most appropriate solution to improve your situation.
Our expert Consultant Orthopaedic Surgeons understand the importance
of the decision you are making when contemplating surgery of this kind.
Throughout your consultation you will be encouraged to ask as many
questions as you wish and to take your time in making a decision to
proceed with any recommended treatment.
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