Carpal Tunnel Syndrome

Carpal tunnel syndrome

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is a condition that occurs when the median nerve, which controls sensation and movement in the hand, becomes compressed as it passes through the carpal tunnel in the wrist. The carpal tunnel is a narrow passageway formed by the bones of the wrist and a fibrous band.

Compression of the median nerve can result in symptoms like pain, tingling, numbness, or weakness in the hand, which may be felt during the day or at night. In severe cases, it can cause a weakened grip, affecting daily activities. Carpal Tunnel Syndrome is often diagnosed through a clinical examination and can be confirmed by nerve conduction studies. Early diagnosis and treatment are important to alleviate symptoms and prevent further complications. To avoid any delay in booking your surgery, you can ask your referring GP to refer you for a nerve conduction study prior to attending the appointment with your chosen specialist.

Causes & Risk Factors of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) can develop due to various factors that increase pressure on the median nerve in the wrist. Understanding these causes and risk factors is crucial for the early identification and prevention of the condition.

Causes:
  • Repetitive Hand Movements: Continuous tasks like typing, using a mouse, or assembly line work can increase pressure on the median nerve.
  • Injury or Trauma: Fractures or sprains to the wrist can alter the structure of the carpal tunnel, resulting in nerve compression.
  • Pregnancy: Hormonal changes during pregnancy can cause fluid retention, resulting in swelling and increased pressure on the median nerve.
  • Health Conditions: Conditions like diabetes, rheumatoid arthritis, and hypothyroidism can affect nerve function and increase susceptibility to CTS.
Risk Factors:
  • Age: CTS is more common in adults, especially those over 40.
  • Gender: Women are at higher risk due to a smaller carpal tunnel.
  • Genetics: A family history of CTS or naturally smaller carpal tunnels can increase risk.
  • Obesity: Excess weight adds pressure to the carpal tunnel, increasing the chance of nerve compression.
  • Work-Related Factors: Jobs involving repetitive hand movements, such as construction or data entry, increase the likelihood of developing CTS.

How Carpal Tunnel is Diagnosed

Diagnosing carpal tunnel syndrome involves a combination of physical examinations, medical history review, and diagnostic tests to confirm the condition and assess its severity.

  • Clinical Examination:
    • The doctor performs a physical exam to check for signs of nerve compression and evaluate wrist movements.
    • Tests such as Phalen’s test (wrist flexion) and Tinel’s sign (tapping over the median nerve) are used to provoke symptoms and assess nerve involvement.
  • Medical History:
    • The doctor reviews the patient’s medical history to identify risk factors like repetitive hand movements, underlying conditions (e.g., diabetes, rheumatoid arthritis), or previous wrist injuries.
  • Nerve Conduction Studies (NCS):
    • Measures the speed of electrical impulses through the median nerve.
    • Slower nerve conduction speeds confirm the presence of nerve compression, a primary indicator of CTS.
  • Electromyography (EMG):
    • Assesses electrical activity in muscles to determine if nerve compression has impacted muscle function, aiding in confirming the diagnosis.
  • Imaging (Ultrasound or MRI):
    • Imaging tests may be used to rule out other conditions, such as tendonitis or arthritis that can present similar symptoms.

Early diagnosis using these methods helps manage carpal tunnel syndrome and prevent further nerve damage.

Non-Surgical Treatment Options for Carpal Tunnel Syndrome

Non-surgical treatments for carpal tunnel syndrome (CTS) aim to relieve symptoms and prevent further nerve damage. These options are often recommended for mild to moderate cases before considering surgery.

  1. Wrist Splints:
    • Wearing a wrist splint, especially at night, can help keep the wrist in a neutral position, reducing pressure on the median nerve and alleviating pain and tingling.
  2. Anti-Inflammatory Medications:
    • Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce inflammation and relieve pain associated with CTS.
  3. Steroid Injections:
    • In some cases, corticosteroid injections into the carpal tunnel can provide temporary relief from inflammation and swelling, easing symptoms like pain and numbness.
  4. Physical Therapy:
    • A physical therapist can teach exercises that strengthen the wrist and improve its flexibility, reducing pressure on the median nerve.
  5. Activity Modification:
    • Avoiding repetitive hand movements or adjusting work ergonomics can help reduce strain on the wrist and prevent further compression of the median nerve.

If non-surgical methods do not provide relief, surgical options may be considered to address severe or persistent CTS symptoms.

Carpal Tunnel Surgery

When non-surgical treatments fail to alleviate symptoms of carpal tunnel syndrome (CTS), surgery may be recommended. CTS involves releasing the pressure on the median nerve by cutting the ligament that forms the roof of the carpal tunnel. This procedure is typically performed under local anaesthesia and can be done through open surgery or minimally invasive endoscopic techniques.

  1. Open Carpal Tunnel Release Surgery:
    • The surgeon makes a small incision in the palm of the hand to access the carpal tunnel and release the ligament. This procedure provides direct access to the area but requires a slightly longer recovery time.
  2. Endoscopic Carpal Tunnel Release:
    • A less invasive option, this technique uses a small camera and instruments inserted through small incisions to release the ligament. It typically offers faster recovery and less post-operative pain.

After surgery, patients typically experience relief from pain, tingling, and weakness. Recovery involves a period of rest and rehabilitation, including physical therapy to regain strength and flexibility in the wrist.

Why Choose Plastic Surgery Central?

At Plastic Surgery Central, we offer personalised, patient-focused care led by the expertise of Dr. Jack Harbison, who specialises in both cosmetic and reconstructive surgery. With years of experience, particularly in complex cases like carpal tunnel syndrome and post-weight loss surgeries, Dr. Harbison ensures each patient receives the highest standard of care.

Our approach prioritises clear, educational communication, so you can make informed decisions about your treatment and recovery. We provide access to private, high-quality surgical facilities at Central Day Surgery, which offers a smooth, comfortable experience with easy access and on-site parking.

Our commitment to your health extends beyond surgery, as we offer comprehensive aftercare, including personalised rehabilitation and follow-up consultations to support your recovery. At Plastic Surgery Central, we are dedicated to supporting your recovery and well-being, ensuring your confidence and well-being throughout the process.

Treatment of carpal tunnel syndrome depends on the duration and severity of symptoms. In mild cases it may be managed by wearing a splint at night to relieve symptoms. However, in many cases surgery is indicated to relieve the compression on the median nerve. This involves releasing the fibrous band at the front of the wrist that places pressure over the nerve.

A consultation with your plastic surgeon will enable personalisation of the procedure and care to your unique situation.

Surgery is usually performed as day surgery under either local anaesthetic and sedation or local anaesthetic alone. If you are having sedation, you will need to fast on the day of surgery, and organise a support person to take you home and be around to help in the first few days after surgery.

After surgery, your hand will be wrapped in a bandage for comfort. After a few days, you will be able to remove this and start to move your fingers and use your hand for light activities.

A post-operative appointment will be organised for you to see your plastic surgeon 1-2 weeks after surgery to check your wounds, remove sutures and provide advice to care for your hand as you recover. Generally you will not be able to drive for 2 weeks after surgery and will need between 2-4 weeks off work depending on your type of work (manual work vs office based work).

Resolution of symptoms of carpal tunnel syndrome is related to their duration and severity. In general, symptoms of pain will resolve within a few days after surgery once the nerve compression is relieved. Symptoms of numbness and tingling can take longer to resolve.

All operations have risks, though major complications are rare after carpal tunnel surgery. There is a small risk of concerns that may delay healing and require a little extra care (eg minor bleeding, infection, or over active or sensitive scars). Very rarely there is a risk of injury to the median nerve or one of its branches. Very rarely there is a risk the fibrous band may not be completely released which may lead to ongoing compression of the median nerve.

These risks may vary depending on your specific situation and will be discussed with you at your consultation. Please feel reassured that your plastic surgeon will only recommend surgery if they feel that the benefit of the procedure substantially outweigh the risks.

If you have carpal tunnel syndrome, the majority of the cost is rebatable through Medicare and standard private health insurance. This does require a referral from your family doctor.

After your consultation, a detailed quote will be provided to you including the surgeon fee, anaesthetic fee and hospital fee.

Our Hand Surgeons

Request a call back

You can use this form to request a call back.
Please be aware that all surgical procedures require a consultation with our plastic surgeons to allow a thorough assessment and discussion of your specific needs.

NSQHS
Central Day Surgery