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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

Carpal tunnel syndrome is common in our community. Surgery can relieve pain and improve hand function.
The carpal tunnel is a narrow space between the wrist and the base of the hand. The median nerve, and flexor tendons pass through that passage. The median nerve is responsible for the sensation of the thumb, index finger, middle finger, and the radial half of the ring finger. This nerve also supplies some muscle to the thumb. The tendons in this region are responsible for finger bending movements.

When a patient complains of carpal tunnel syndrome, he / she would experience numbness, tingling or pain in the distribution of the thumb, index finger, middle finger, and the radial half of the ring finger. The patient can experience pain radiating up the forearm too. The patient usually complains of weakness in thumb muscles, so dropping objects, or having difficultly opening jars is common. The patients grip can also be painful.
Because the sensation is affected, fine movements involving fingertips are often limited. Symptoms are usually worse at night because the wrist often falls into a bent position, and narrows the carpal tunnel passage.

The exact cause of carpal tunnel is not known. Some patients are more prone to it's development than others and it can affect adults of any age.
Pregnant women have been known to build up fluid in the carpal tunnel, which usually resolves itself after the baby is delivered, and the fluid is absorbed. Forceful and repetitive movements can considerably worsen carpal tunnel syndrome.

Conservative management such as a splint at night would prevent the wrist falling into the bent position, and therefore prevent compression of the nerve in the carpal tunnel passage.
Sometimes, steroid injections can reduce inflammation, temporarily until surgery can cure the syndrome.
Surgery for this condition is known as an open carpal tunnel release. An incision of  is made in the palm of the hand and the transverse carpal tunnel ligament is released. The surgeon protects the median nerve. Once the ligament is released, the pressure is alleviated and the nerve is no longer compressed.
The operation can be performed under General or Sedation Anaesthetic.

The wound is dressed with a compression bandage, and the patient is instructed to elevate the hand in a sling or on pillows for a few days.
A plastic bag is used to protect the dressing for showers. Some bruising is normal.
As the fingers are left free, the patient can use his / her fingers for eating utensils, or for the computer. Driving is permitted after a couple of days.
The sutures are removed between 2 to 3 weeks.

Activity is gradually increased, and symptoms are normally resolved between 1 week and several months, depending on the severity of the condition.
If the median nerve has been compressed for a long time in the lead up to surgery, it can take a few months to recover after the operation. Hand therapy can help the patient to regain strength.


Image by Codioful (Formerly Gradienta)

The Risks

Early sequelae include bleeding, wound infection, swelling and stiffness, abnormal scarring, slow healing, wound dehiscence, damage to a nerve, persistent numbness, and complex regional hand syndrome. Later complications include prolonged swelling and stiffness, complex regional hand syndrome, and recurrence.

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