Carpal Tunnel

What is a Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) occurs when the median nerve, which runs from your forearm into the palm of your hand, becomes compressed at the wrist. This nerve passes through a narrow passageway in the wrist called the carpal tunnel, which is made up of bones and ligaments. When the tunnel narrows or the tissues surrounding the flexor tendons swell, they can press on the median nerve, leading to symptoms such as:

Numbness or tingling in the thumb, index, middle, and ring fingers
Pain or discomfort in the wrist and hand
Weakness in the hand, making it difficult to perform fine motor tasks

CTS is more common in women and can be associated with repetitive hand movements, wrist anatomy, or underlying health conditions.

When Should I Seek Treatment?

Consider seeking medical advice if you experience:

Persistent numbness or tingling in your fingers
Night-time symptoms that disrupt sleep
Weakness in your hand or difficulty gripping objects
Symptoms that do not improve with rest or over-the-counter pain relief

Early diagnosis and treatment are crucial to prevent permanent nerve damage.

What is the NHS Criteria for this procedure?
Carpal Tunnel Syndrome (CTS) No prior approval needed

CG 003 - Prior Approval Policy. The patient must be 16 years of age or older.

The ICB will only fund surgical treatment of CTS where one of the criteria are met:

Nerve Conduction studies have been undertaken to confirm carpal tunnel

OR
The symptoms significantly interfere with daily activities and sleep symptoms and have not settled to a manageable level with either one local corticosteroid injection and/or nocturnal splinting for a minimum of 8 weeks

OR
There is either:
- A permanent (ever-present) reduction in sensation in the median nerve
  
  distribution
  
  OR
- Muscle wasting or weakness of thenar abduction (moving the thumb away from the hand)

Can It Be Treated Without Surgery?

Yes, especially in mild to moderate cases. Non-surgical treatments include:

Wrist Splinting: Wearing a splint at night to keep the wrist in a neutral position can relieve pressure on the median nerve.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen can reduce inflammation and alleviate pain.
Corticosteroid Injections: Injecting steroids into the carpal tunnel can decrease inflammation and swelling.
Activity Modification: Avoiding activities that exacerbate symptoms and taking frequent breaks to rest the hands.

If symptoms persist or worsen, surgical intervention may be necessary.

What is Happens During Surgery?

Carpal Tunnel Release is a surgical procedure aimed at relieving pressure on the median nerve by cutting the transverse carpal ligament, which forms the roof of the carpal tunnel. This increases the size of the tunnel and decreases pressure on the nerve.

The Surgeon will inject local anaesthetic around your wrist to numb the area. They will then make a small cut at the base of your palm and release the ligament which is causing pressure over the nerve. The skin is closed with stitches and a light dressing is applied, followed by a heavier bandage.

As the procedure is completed under a local anaesthetic you are able to go home shortly after your appointment. However, you must make arrangements for someone to drive you.

What to Expect Before and After Surgery

Before Surgery:

You will have a consultation with the Surgeon immediately prior to the procedure to discuss risks and benefits.

You can eat and drink as normal on the day of the procedure.

If you take any blood thinning medication, it is important that you advise the Admin team prior to your appointment.

Please remove rings and jewellery from the hand having the procedure. Furthermore, due to the risk of infection, please remove nail polish from both hands.

After Surgery:

Your hand will be bandaged, and you'll be given instructions on wound care. Keep the heavier bandage on and your hand elevated as much as possible for the first 72 hours.
Mild pain, swelling, and stiffness are common but should improve over time. Over-the counter painkillers such as paracetamol and ibuprofen are recommended for 24-48 hours.
Physical therapy exercises may be recommended to restore strength and flexibility.
Most patients return to normal activities within a few weeks, but full recovery can take several months.

What Are the Risks?

While Carpal Tunnel Release is generally safe, potential risks include:

Infection: As with any surgical procedure.
Nerve Damage: Rare, but possible, leading to persistent symptoms.
Scar Sensitivity: Tenderness or discomfort at the incision site.
Stiffness or Pain: In the wrist or fingers during recovery.
Incomplete Relief: Some patients may continue to experience symptoms post-surgery.

Discuss any concerns with your surgeon prior to the procedure.

How Do I Prepare?

Medications: Inform your doctor about all medications and supplements you're taking.

Transportation: Arrange for someone to drive you home post-surgery.
Home Preparation: Set up a comfortable recovery area with necessary supplies within easy reach.

Patients Asking a doctor Questions _edit

Frequently Asked Questions

Q: How long does the surgery take?
A: The procedure typically lasts 30 minutes.

Q: Will I need physiotherapy after surgery?
A: Physical therapy may be recommended to aid in recovery and restore hand function.

Q: How soon will I recover?
A: Recovery time differs for each patient. You can return to work as soon as you feel you have enough strength and movement in your hand to safely do your job. Your symptoms may continue to improve for up to 6 months. You can normally drive a car after 1 week if you have regained full finger movement, are able to make a firm fist and have power to control your vehicle. It may be wise to check with your insurance company beforehand to ensure no restrictions apply.

Q: Are there alternatives to surgery?
A: Yes, non-surgical treatments are available and effective in many cases, especially when symptoms are mild. Please speak to your GP Practice for further advice.