Carpal tunnel syndrome: when is surgery necessary?

Carpal tunnel syndrome is a condition in which compression of the median nerve at the wrist causes pain, numbness and tingling in the thumb, index and middle fingers. Top neurosurgeon Mr Sanj Bassi tells us what happens if you suffer from carpal tunnel syndrome and just when surgery is required…

The carpal tunnel itself is a narrow space covered by a fibrous strip of tissue on the palm side of the wrist bone. The median nerve, as well as the tendons which bend the fingers, run through limited space and therefore if this space is compromised the nerves may be squashed so that they don’t work as well. This is then known as carpal tunnel syndrome.
 

What are the symptoms of carpal tunnel syndrome?

The symptoms of carpal tunnel syndrome include the following:

• Pins and needles and numbness in the thumb, middle finger and half of the ring finger nearest the thumb.
• Pain and aching in the hand and thumb, middle finger and half of the ring finger nearest the thumb. This pain can on occasion travel up the arm.
• The ability to grip has become weakened.
   

Why does carpal tunnel syndrome occur?

In many cases, there is no clear reason as to why carpal tunnel syndrome starts but it is clear that it is associated with pressure on the median nerve. This can be associated with:

• Pregnancy – as fluid retention associated can cause swelling.
• Wrist dislocations and fractures - which put pressure on the median nerve.
• Bone or arthritic conditions (rheumatoid arthritis) – these conditions can be associated with thickening of the ligament at the carpal tunnel, narrowing the space.
• Side effects of some medication - for example, the combined oral contraceptive pill can disrupt the hormonal balance.

Other conditions including obesity, diabetes or menopause can increase water retention resulting in compression on the median nerve.
 

When would surgery be needed?

If symptoms persist and are not relieved by medication or exercises then surgery may be an option. Surgery involves either local anaesthetic to numb the wrist area during surgery or general anaesthetic. During the surgery, the surgeon will cut the ligament over the front of the wrist with the aim of relieving pressure on the median nerve.

After surgery, in most cases, patients can return home on the same day as the procedure. To help prevent swelling in the fingers the arm is kept raised and can stay on the pillow when resting. Wiggling the fingers and making a fist regularly also helps reduce finger swelling. Most individuals (depending on their type of job) return to work and most daily activities in approximately two weeks.