Carpal Tunnel Syndrome

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What is it?

Carpal tunnel syndrome is caused by a build up of pressure
within the bony and fibrous tunnel (carpal tunnel) which
carries tendons and a major nerve (median nerve) to the hand
and fingers. When pressure occurs in this tunnel the nerve
is starved of blood and symptoms of tingling, numbness and
even pain may occur. These symptoms are often worse a t
night and can extend up the arm into the shoulder.
Nobody knows what causes carpal tunnel syndrome most of
the time. It just seems to happen. It is more common in som e
conditions such as diabetes, rheumatoid arthritis, pregnancy
and occasionally after trauma, but in most people there is no
identifiable cause.

Are there any tests I need?

Yes. Nerve conduction studies are always performed and no t
only help confirm the diagnosis, but can be repeated ove r
intervals if required to see the effect of treatment, or if th e
condition is worsening before surgery. Usualy however they
are only performed once.

How is it treated?

There are a number of conservative methods available to trea t
carpal tunnel syndrome, including splinting to keep the wris t
in a non-aggravating position during sleep, anti-inflammatory
medications, or cortisone injections into the wrist to relieve
the pressure which causes carpal tunnel compression. Usually
these do not provide more than temporary relief.
If conservative methods fail to control symptoms of carpal
tunnel compression, surgical decompression can be performed .
This operation involves division of the carpal tunnel fibrous
portion (flexor retinaculum) which immediately “lets the
pressure off” and provides instant relief from pain and
symptoms. The ligament heals, creating a bridge between
the divided area and increasing the overall size of the carpal
tunnel. Mr Callan uses a less than two centimetre incision to
divide the ligament and provide relief.

Is Mr Callan experienced at this procedure?

Mr Callan has over 20 years experience at this procedure. He
performs carpal tunnel release regularly and keeps up to date
with the latest techniques. As a fully trained plastic surgeon,
Mr Callan performs this procedure to the highest standard

What are the results of surgery?

Usually very good. Relief is immediate. If it has been lef t
untreated for a long time, ful recovery may not occur as
the constant pressure on the nerve has caused permanent
damage. This is unusual.

What happens after surgery?

After surgery the hand is rested in a bandage. It is ver y
important to elevate the hand to minimise swelling. The
bandage comes off the next day and the hand can be used
gently, but not for any heavy activities. There is usually no
pain. The hand can get wet so you can wash your hands .
A small proportion of people have difficulty with moving
and can have a painful stiff hand for some weeks. A few
people develop a painful condition caled reflex sympathetic
dystrophy or chronic regional pain syndrome, with sweating ,
stiffness and sensitivity to cold. It is very rare.

I have it in both hands. Can they both be done at once?

Most definitely. As the disability from the surgery is not grea, t
and you can feed dress and wash yourself, many people avoid
two periods of convalescence by having both done at once.
How long do I need to recover?
Usually you will need a month. After two weeks most people
function very well, but it is best to diminish activity with
the hands for three weeks, and then build to full function
by six weeks. Too much early activity can weaken the grip
permanently. You must not drive until you are fully recovered
from both the anaesthetic and the discomfort of surgery. This
could be a few weeks. If in doubt, don’t.

And the future?

Carpal tunnel release is usualy a permanent fix. Very
occasionally symptoms may recur and further investigation
is required. Often it is not a recurrence of carpal tunne l
syndrome but another condition such as trigger finger or
arthritis which can usually be managed very easily.

Will I need to be seen after surgery?

Yes. We will keep in close contact with you by telephone fo r
the first few days, then wil see you about ten days after
surgery. You are of course welcome to call or visit any time
with any concerns.