Carpal tunnel syndrome causes tingling, numbness and sometimes weakness or clumsiness in the hand. It is caused by compression of the median nerve in the area of the wrist. Early carpal tunnel syndrome can be managed with splints or steroid injections, but some patients may need to have the median nerve surgically released to reduce or cure the symptoms.
Traditionally, the surgery is performed using an incision in the palm of the hand. This has the disadvantages of causing a delay in return to normal activities and not being able to have both sides treated at once. However, I offer endoscopic carpal tunnel release, which involves an incision in the skin at the wrist and means that both hands can be treated at the same operation.
Carpal tunnel syndrome is a condition where one of the main nerves to the hand (which is called the ‘median nerve’) stops working properly. The nerve crosses the wrist into the hand from the forearm in a tunnel, which is called the carpal tunnel. The tunnel is a tight space surrounded by bones and a ligament. The nerve can become squashed in the tunnel, which then leads to symptoms in the hand. Symptoms of carpal tunnel syndrome include pins and needles, numbness or weakness in the hand.
An endoscope is a medical device that allows us to look inside the body and perform surgery without having to make large incisions.
If you are having intermittent symptoms, for example pins and needles only at night, a simple treatment such as a splint can be enough.
If your symptoms are more frequent or constant, then an injection of steroid into the carpal tunnel can help relieve your symptoms. This is done in the out-patient clinic.
Most patients will require surgery for their carpal tunnel syndrome. The aim of surgery is to divide the ligament that forms part of the carpal tunnel to increase the space around the median nerve. This in turn reduces the pressure on the nerve and should improve the symptoms you are having. It is important to realise that we cannot guarantee that all of your symptoms will go after the operation. This is because if there is already scarring in the nerve before the operation, this cannot be changed by the operation. However, the operation should stop the symptoms getting any worse by stopping any further damage to the nerve by pressure.
Surgery is usually performed as a day-case procedure with you awake but with the area numbed with a local anaesthetic injection. The injection is a little sore to have done, but once it is working you don’t feel any pain.
Traditionally, an incision is made in the palm of the hand and may extend a little into the forearm. The ligament is released and the skin is sutured. This is called an open carpal tunnel release.
In an endoscopic carpal tunnel release, an incision is made in the forearm, not the hand. An endoscope is used to see the ligament from inside the hand and it is divided without having to cut the skin on the hand.
There are several proven advantages to an ECTR:
There are no differences between the rates of complications comparing endoscopic and open carpal tunnel release. Risks of a carpal tunnel release include, but are not limited to:
Infection, requiring antibiotics or further surgery
A sensitive or tender scar requiring further treatment
Delayed wound healing, requiring dressings
Injury to the median nerve leading to permanent numbness or weakness in the hand
Incomplete or slow relief of symptoms
Complex Regional Pain Syndrome, which can make your hand painful, stiff and needing intensive hand therapy. This is very rare, occurring in only 1:3000 patients having any form of hand surgery or treatment.
For the first week, you should use your hand as pain allows. You should avoid activities that involve strong gripping eg driving, lifting heavy things. You can wash and shower from the first day but should replace the dressing with a plaster if it becomes soggy. Avoid soaking baths for the first week and swimming for the first 2 weeks. The stitches are all dissolvable and do not need to be removed routinely. If you find that your hand is becoming too painful to use or stiff, you must contact us as you may need some hand therapy to help your hand heal.