Carpal tunnel syndrome is one of the most common conditions affecting the hand and wrist, causing combinations of numbness, tingling and weakness in the hand that can significantly interfere with daily life. Pain can also be felt in the forearm. Diagnosis can usually be made on the basis of medical examination alone but occasionally additional tests are required. Effective surgical and non-surgical treatments are available.

doctor checking patient for carpal tunnel

Understanding The Condition – What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) occurs when pressure and inflammation build up around the Median nerve — which travels from the forearm into the hand through a narrow tunnel at the wrist called the carpal tunnel.

This tunnel is formed by the bones of the wrist on three sides and a strong ligament (the transverse carpal ligament) across the top. It shares this space with the finger tendons.

Carpal tunnel syndrome is extremely common and affecting 1 in 20 people. All adult age-groups can be affected, though it is more prevalent in women and it is more prevalent with increasing age.

Sometimes it can remain mild or intermittent. In more severe cases the symptoms become continuous and if these more severe cases are not treated it may be impossible to fully treat the condition.

It may be present in one hand or both. Because it is such a common condition, it may occur in conjunction with other hand conditions.

Common Symptoms – Recognising the Signs

There are a collection of features. Not all of these are always present.

  • Tingling / burning sensations in the fingers / thumb
  • Numbness in the affected fingers.
  • Weakness when gripping or pinching
  • Dropping objects unexpectedly
  • Aching or pain in the wrist and hand or forearm
  • Difficulty with fine motor tasks such as fastening buttons or using a keyboard
  • Sensation of swelling in the fingers even when none is visible
  • Symptoms usually in thumb, index or middle fingers
  • Symptoms relieved by shaking the wrist
  • Symptoms occur or worsen at night or early morning
  • Symptoms occur or worsen with certain activities

Causes and Risk Factors

Anatomy & Genetics

Just in the same way that humans come in all shapes and sizes, some people are born with a naturally narrower carpal tunnel, making them more susceptible. This is increasingly thought to be the most usual background cause. It follows that if you are quite likely to have blood-relatives who have had carpal tunnel.

Repetitive Hand Use

People who do very repetitive activities at work or at home may be prone to this condition. It is probably the case that this condition was always there in the background but lifestyle prohibits rest when the condition first arises.

Health Conditions

Diabetes, rheumatoid arthritis, thyroid disorders, obesity are associated with higher rates of CTS. It may also be caused by pregnancy; sometimes the condition will settle once pregnancy is completed and other times it may persist.

Wrist Injuries

Previous fractures or dislocations of the wrist can cause swelling of adjacent tissues or alter the shape of the carpal tunnel, increasing pressure on the nerve.

Sex & Age

Women are three times more likely than men to develop carpal tunnel syndrome. The condition becomes increasingly common from middle age onwards.

How is it Diagnosed

Clinical assessment:
Mr Harley will take a detailed history of your symptoms and examine your hand and wrist carefully. Simple clinic-room tests and assessments will often help to confirm the diagnosis.

Nerve Conduction Studies (NCS): These are specialised electrical tests which may be helpful to confirm the diagnosis and assess the degree of nerve compression. They can also rule out other causes of similar symptoms such as a trapped nerve in the neck. Some patient’s may have a combination of nerve problems. Nerve tests may not necessary if the clinic assessment clearly points to a diagnosis of CTS but they are used if the pattern of features is less clear. If you have previously had Nerve tests, please try to bring or send the results.

Trial of steroid injection: Sometimes it can be helpful to confirm diagnosis by use of a steroid injection.

Ultrasound imaging: of the wrist can also be used to help with diagnosis but this has the disadvantage of being unable to look for other nerve-related symptoms so it is generally less useful.

Surgical Overview

  • Anaesthetic: Local

  • Time: Approximately 20-30 minutes

  • Hospital stay: Day case – home same day

  • Dressings off: 10-14 days

  • Light activities: Straight away

  • Manual work: 4-6 weeks

  • Recovery: Plan a quiet week or two at home. Need to avoid forceful activities for 6 weeks

  • Further Details: See patient information document below

Your Treatment Options

The right treatment will depend on the severity of your symptoms, how long you have had them, and the results of nerve conduction studies. Mr Harley will discuss all options at consultation and guide you to the most appropriate approach.

Non-Surgical Treatments are often the first step for mild to moderate cases:

  • Wrist splinting — worn at night to keep the wrist in a neutral position, reducing pressure on the nerve
  • Activity modification — avoiding positions and tasks that worsen symptoms
  • Corticosteroid injection — can provide effective relief, particularly in early or mild cases and in pregnancy-related CTS

Surgical Treatment — Carpal Tunnel Release is recommended when:

  • Non-surgical measures have not provided lasting relief,
  • When symptoms are severe,
  • When fingers are regularly/continuously numb
  • When there are signs of muscle weakness or wasting at the base of the thumb.

Night-time symptoms, tingling and numbness typically improve quickly after the operation.
Recovery of strength and resolution numbness may take several months, depending on the degree of pre-operative nerve compression.
There may be residual swelling and scar sensitivity for several months.
The majority of patients experience significant or complete improvement in their symptoms following surgery, with long-lasting results.
As with all types of operation, there may be a minority of cases who have little or no benefit, who have recurrence of symptoms despite initial success or who develop other problems from the surgery.

Frequently Asked Questions

How do I know if I need surgery?

Surgery is usually recommended when symptoms are persistent and significantly affecting daily life or sleep, when non-surgical treatments have not provided lasting relief.
Where there is weakness or persistent numbness on testing, surgery will usually be advised to minimise permanent loss of nerve function.

Will the surgery cure my carpal tunnel syndrome?

Carpal tunnel release surgery has a high success rate. Night symptoms and tingling typically resolve quickly. Numbness, especially if this is continuous, will often recover sensory function more slowly and it may be an incomplete recovery.

Is carpal tunnel surgery painful?

The procedure is performed under local anaesthetic so you will have some pain as the local anaesthetic injections are given. This works quickly and you should usually feel no pain during the operation. After surgery, most patients experience mild soreness in the palm but some patients will find the scar more sensitive and bothersome. Significant pain following carpal tunnel release surgery is uncommon but all types of hand surgery have the potential to trigger off an excessive pain response called CRPS.

How long will I be off work?

This depends on the nature of your work. Light activities can be commenced straight away; if you have a reasonably relaxed office job or work from home, you could potentially be back at work the following day. Those whose work is very repetitive or forceful may need to take longer periods of time off work or with amended duties. The surgical scar has the potential to split open with strong activity or stretching during the first 4 weeks after surgery.

Is a steroid injection a good alternative to surgery?

A corticosteroid injection can provide very effective relief for mild cases in upto 80% of cases. The effects are rarely permanent with most patients requesting a further injection or progress to surgery within a year. It is possible to repeat injections as long as the severity does not worsen.

Can carpal tunnel syndrome come back after surgery?

Carpal tunnel syndrome can return but this is unusual. In approximately 1 per 100 cases it may return within a year. Possibly 1 per 10 cases will have recurrence over a much longer period of time (within 10 years).

doctor testing for carpal tunnel syndrome

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