Carpal tunnel syndrome: causes and treatment

What is the cause of carpal tunnel syndrome?

Any condition can cause carpal tunnel, but it’s mainly provoked by conditions which cause swelling in the carpal tunnel itself.

Examples of these conditions include diabetes, pregnancy, arthritis, injuries (mainly to the hand) and thyroid disease.

What are the common signs and symptoms?

The majority of people with carpal tunnel complain of numbness and tingling i.e.  pins & needles, in the the thumb, index, middle and half the ring finger.

They also complain of their hand being clumsy, causing them to drop things regularly. They also sometimes have pain around the palm, going into the thumb.

Depending on how long they’ve had the condition,some patients may have thiness or wasting of the muscle and reduced sensation in the thumb, index, middle and half the ring finger compared to the other side .

If you tap around the palm, there can be some tingling. Additionbally, if you bend the wrist, or compress and bend, that makes symptoms worse.

People also often complain of symptoms worsening at night.

Can carpal tunnel syndrome go away on its own?

Carpal tunnel syndrome can go away by itself, if the condition that could have caused it gets treated.

Most pregnant women find that their symptoms get better after they’ve had their baby.

Rheumatoid arthritis patients and thyroid patients sometimes have improvement in symptoms once the disease is treated.

When is surgery recommended and how is it performed?

Surgery is perfromed if the patient has symptoms that have progressed and have not improved with conservative treatment.

This means surgery will be performed if they’ve used a splint at nightime and it’s made no difference or if they’ve had a cortisone and local anesthetic injection into the carpal tunnel and that’s made no difference.

The surgery is performed under local anesthetic, which is normally injected into the palm. It feels like a bee sting when it happens.

The following steps depend on the patient. Sometimes a tornocay, which is a blood pressure cuff, is used up at the top of the arm. If inflated, this lasts around 10 minutes.

Afterwards, the doctor will clean the hand and then make a cut about 4/5cm in the palm in line with the ring finger web space.

They will divide the ligament which is causing compression of the nerve, free the nerve up, buzz any vessels and then stitch it all up and put a dressing on top.

The surgery doesn’t take long. It only lasts around 10-15 minutes.

What is recovery like?

The surgery involves having the dressing removed in about 48 hours after the surgery. Then, a little light dressing is added. Patients can move the hand, and start using it for light activites

Stiches are removed at around 10-14 days. Afterwards the scar will be massaged

Most people find that the numbness to the end of their fingers gets better but if you’ve had it for a long period of time, that numbness doesn’t always get better. However, it  doesn’t get worse from the operation.

Night pain goes away automatically. Most people find that by three months, the residual discomfort that they’ve had in their fingertips, if they’ve had it acutely, gets much better.

Their grip strength, in the nerve, can take up to six months to get better. It never goes back to the original, pre-condition strengh but it goes back to about 80%.

Most people go back to work after a couple of weeks, depending on their job.

They normally drive after a couple of weeks, when the scar has healed.  

How effective is carpal tunnel syndrome surgery?

Effectivness depends on how long you’ve had the condition.

If you present quite acutely and haven’t had it for years and years, your symptoms in that pain will normally go right away, but any ultra-sensation in the fingertips, can take about three months to improve.  

Regarding patients who’ve had it for longer, it may not get better, surgery just stops it from getting worse.  

A 2011 systematic review in the journal of orthopaedics & research which compared conservative treatment to surgery demonstrated favourable results for both.

However, surgery performed slightly better and showed patients had improves well about 6 or 12 months after having the surgery

What is recommended to surgeons is that they conservative treatement. If it doesn’t work, then they consider surgery.