Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand and forearm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.
In most patients, carpal tunnel syndrome gets worse over time. If untreated for too long, it can lead to permanent dysfunction of the hand, including loss of sensation in the fingers and weakness. For this reason, it is important to diagnose and treat carpal tunnel syndrome promptly.
Early symptoms can often be relieved with simple measures like:
- Wearing a wrist splint while sleeping
- Exercises to keep the nerve mobile
- Avoiding certain activities that aggravate your symptoms
- A steroid injection into the carpal tunnel
If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients.
Nonsurgical Treatment
If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be relieved without surgery. If your diagnosis is uncertain or if your symptoms are mild, your doctor will recommend nonsurgical treatment first.
Nonsurgical treatments may include:
Bracing or splinting. Wearing a brace or splint at night will keep you from bending your wrist while you sleep. Keeping your wrist in a straight or neutral position reduces pressure on the nerve in the carpal tunnel. It may also help to wear a splint during the day when doing activities that aggravate your symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory medications such as ibuprofen and naproxen can help relieve pain and inflammation.
Activity changes. Symptoms often occur when your hand and wrist are in the same position for too long — particularly when your wrist is flexed or extended.
If your job or recreational activities aggravate your symptoms, changing or modifying these activities can help slow or stop progression of the disease. In some cases, this may involve making changes to your work site or workstation.
Nerve gliding exercises. Some patients may benefit from exercises that help the median nerve move more freely within the confines of the carpal tunnel. Specific exercises may be recommended by your doctor or therapist.
Steroid injections. Corticosteroid, or cortisone, is a powerful anti-inflammatory agent that can be injected into the carpal tunnel. These injections often relieve painful symptoms or help to calm a flare-up of symptoms. However, they typically provide only temporary relief and not long-term benefit.
A cortisone injection may also be used by your doctor to help diagnose your carpal tunnel syndrome.
Surgical Treatment
The decision of whether to recommend surgery is based on:
- The severity of your symptoms
- Physical exam findings
- Response to non-operative treatment
- Results of testing
In long-standing cases with constant numbness and wasting of your thumb muscles, surgery may be recommended to prevent irreversible damage. Surgery may also be recommended if you do not get relief with non-operative treatments and/or demonstrate significant nerve changes on testing.
Surgical Procedure
I perform open carpal tunnel release /decompression under local anaesthesia (injecion to make the wrist numb while you are awake). The procedure takes 15 minutes operating time or so. It leaves a short scar over the wrist region.
Recovery From Surgery
Immediately after surgery, you will be encouraged to elevate your hand above your heart and move your fingers to reduce swelling and prevent stiffness.
You should expect some pain, swelling, and stiffness after your procedure. Minor soreness in your palm may last several weeks to several months. This can typically be treated with paracetamol and/or Ibuprofen.
Nighttime symptoms improve dramatically for most patients in the first week or so after surgery.
Grip and pinch strength
- Grip and pinch strength usually return by about 2 to 3 months after surgery.
- If the condition of your median nerve was poor before surgery, grip and pinch strength may not improve for about 6 to 12 months.
- In very severe cases, the normal strength you had before you developed carpal tunnel syndrome may not completely return. However, surgery is still important in these cases to prevent worsening of the condition and function of the nerve/hand.
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Numbness and tingling - Numbness and tingling tend to improve over the first several months after surgery.
- Some patients with mild disease may experience return of sensation right away.
- Patients with severe disease may not have normal sensation in their fingertips for 6 to 12 months after surgery.
- In very severe cases, some patients may never completely regain normal sensation. Again, surgery is still important in these cases to prevent the condition from getting worse.
You may have to wear a splint or wrist brace for several weeks after surgery. You will be allowed to use your hand for light activities, taking care to avoid significant discomfort. Driving, self-care activities, and light lifting and gripping may be permitted soon after surgery.
Your doctor will talk with you about when you will be able to return to work and whether you will have any restrictions on your work activities.
Complications
Although complications are possible with any surgery, your doctor and surgical team will take steps to minimize the risks. The most common complications of carpal tunnel release surgery include:
- Bleeding
- Infection
- Wound healing issues
- Nerve aggravation or injur
