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Glenelg Orthopaedics

Providing Quality Orthopaedic Care

Carpal Tunnel

 Diagram of the wrist and location of the carpal tunnel.

Carpal Tunnel Syndrome: 

Whilst this diagnosis is put on nearly any condition that occurs in the hand, the real condition involves compression of the median nerve in the wrist.  The carpal tunnel consists of a collection of bones called the carpal bones in the wrist which are placed and spaced out in a curve, almost like a roman arch only upside down.  The tendons and nerves to the fingers go through this area and it is enclosed by a ligament which compresses the tissues and keeps it close against the bones.  With age, thickening of the ligaments around the bones as well as thickening of the tendons ( along with a predisposition in some people) , the median nerve can be squeezed by lack of space and this partially strangulates the nerve.  This leads to a sensation of pins and needles affecting the thumb side of the digits of the thumb, index finger, long finger and half of the ring finger. 

The symptoms most commonly occur at night when the patient will wake and have to shake their hand around or during the day time it can occur particularly when gripping things such as when driving, holding a mobile phone or riding a bike.  It is very common and can cause an ache up the forearm and even up to the shoulder.

 

What treatments are available for carpal tunnel?

It is important to exclude other causes of similar symptoms.  Nerve involvement can occur for several reasons, firstly carpal tunnel is associated with thyroid abnormalities, pregnancy and other hormonal variations.  Secondly the nerve itself can be damaged by causes other than being squeezed in the carpal tunnel such as diabetes and smoking or other central conditions that can cause carpal tunnel type symptoms such as nerve compression in the neck or multiple sclerosis. If there is any concern then an MRI scan of the cervical spine may be required but the best test is nerve conduction study done by a qualified neurologist to confirm that the nerve is being compressed in the wrist. 

Treatment involves initially symptomatic measures such as a night brace and physiotherapy but the vast majority of people do not respond long term to these measures and as such surgery is required, which is release of the ligament over the nerve to allow the nerve to have some room and not be compressed.  This surgery can be undertaken in numerous ways. Whilst some people advocate a telescopic approach we believe an open approach is a safer method with good results, which can be undertaken in the vast majority of people under a local anaesthetic thus avoiding the cost and risk of a general anaesthetic. By doing so the patient to be involved in the surgery so that that they are able to even see what is being undertaken. 

"Under Local Anaesthetic, and as Day Surgery, the out of pocket costs are kept to a minimum, the hand is encougarged to be used immediately and the return to Full Activities in the majority of patients is within 2-3 weeks."

     

How quickly does a patient recovery from carpal tunnel release?

After carpal tunnel surgery the patient is encouraged to use their hand as quickly as possible but not undertaking tasks that may cause damage or put them at risk, ie driving a car, holding a boiling hot kettle or iron, or using the hand to climb.  With these exceptions and the exception that we like to keep the wound dry for five days, we encourage the hand to be used as soon as possible.

What is the success rate of this surgery?

The success rate is in the order of 98%.  This still means that one in fifty people may not get a recovery or improvement but ninety eight out of a hundred do. 

 

Are there any complications?

Occasionally a patient will develop a superficial wound infection and may warrant a course of antibiotics but it would be extremely unlikely for the patient to require anything more serious.  Also at the site of the surgery the area can remain tender for a period of time but this improves the more one uses the hand.

Glenelg Orthopaedics providing Quality Orthopaedic Care

At Glenelg Orthopaedics, we pride ourselves on providing quality orthopaedic care.  This means we make sure you have good advice, choice of treatments, careful & precice surgery if it is required, and comprehensive recovery care. Call us on 8376 9988, to discuss your options for treating carpal tunnel syndrome.

Read about some of the benefits of surgery at Glenelg Orthopaedics