Carpal tunnel syndrome is caused by pressure on the median nerve. The median nerve passes through the carpal tunnel in your wrist to reach your hand. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm of your hand. 

Your median nerve controls the feeling in thumb index middle and ring fingers. It also controls muscles in your thumb.

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When it is compressed it leads to the symptoms of numbness, tingling, pain and weakness. Some patients may also experience burning feelings.

The narrow channel (carpal tunnel ) is formed from your wrist bones and a tough band of tissue known as the transverse carpal ligament.

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Causes of carpal tunnel syndrome include;

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• Certain health conditions such as Diabetes and Thyroid disorders

• Arthritis

• Being overweight

• Pregnancy

• Injury to your wrist such as a fracture

• Some inflammatory conditions such as rheumatoid arthritis

• Treatment with carpal tunnel release usually relieves the tingling and pain and restores wrist and hand function.

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Pre-operative assessment

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You have been referred to the service with suspected carpal tunnel syndrome. Usually patients have already tried simple techniques on the advice of their doctor to help their symptoms.

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These may include cessation of certain activities, treatment of underlying disorders or wearing splints. Steroid injection to the wrist may also have been helpful for a time in settling swelling around the nerve.

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You will be assessed for symptoms and signs of carpal tunnel and any preceding investigations organised by your GP such as nerve conduction studies or imaging may be helpful in determining the need for surgery. However these are not usually necessary and the diagnosis in the majority of cases can be made clinically at the appointment.

Consent

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Once the assessment has taken place if you require surgery your doctor will explain consent for the procedure explaining any possible risks and complications, such as infection and small risk (around 1 in 100) of nerve injury.

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Carpal tunnel release

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The operation involves releasing the nerve by splitting the ligament that encloses it at the wrist.

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Post operative advice

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Your arm will be best kept in a sling for two days after the procedure top reduce swelling and hence infection. finger movements, after stitches, movements of nerve glide and tendon glide.

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• Keep the wound dry until the stitches are removed at day 12.

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• Pain medication can be used for post operative pain and usually patients take simple analgesia such as paracetamol or non steroidal anti-inflammatories if they are indicated.

 

• It is important to remember your wrist will not be back to FULL strength for a number of weeks , usually 12 weeks after the procedure.

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• Symptoms to look out for in terms of infective complications are swelling , throbbing from the wound site with the potential for the skin locally to appear more red to the eye.

 

• Bathing/shower- you can bath or shower but please remember to keep your wound dry until the stitches are removed.

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• Driving-you can start driving after the removal of stitches

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• Recovery- The ligament divided at operation needs to reform over 12 weeks before your hand is back to full strength. During this phase the hand can feel sore and weak. We would encourage you to use the hand for day to day activities once stitches are removed but avoid heavy lifting for at least 6 weeks until telephone review.

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• The scar – this will be tender at first but will soften and fade with time. You may massage with E45 cream or Bio-oil from the chemist.

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• When to seek advice post operatively - if you have persistent pain which is progressively worsening day on day, associated with a throbbing swollen hand this may be a sign of infection. You can contact either your Bideford Medical Centre on 01237 476363 or your local GP or 111 services out of hours to have the wound evaluated.