Carpal Tunnel Syndrome

Problem

  • Numbness and tingling affecting the thumb, index, middle and ring fingers

Cause

  • Compression of the median nerve as it passes through the carpal tunnel at the level of the wrist.

Diagnosis

  • Characteristic night time waking with numbness
  • Characteristic distribution of numbness in the hand
  • Sometimes wasting of the thenar (thumb) muscles in the hand
  • Positive Tinnels (tapping) and Phalens (compression tests
  • Nerve Conduction Tests can confirm the diagnosis if needed.

Treatment

Non Op

  • Night splinting
  • Steroid injection for temporary relief

Op

  • Open – LA with sedation or GA
  • 4cm Incision
  • Release of the transverse carpal ligament
  • Skin Closure

Endoscopic – GA

  • Using an endoscope to divide the ligament between the smaller incisions
  • Same long term results as open
  • Slightly earlier return to work than Open
  • Bilateral procedure possible

Potential Complications

  • Infection, Haematoma
  • Wound sensitivity
  • Pillar pain (thenar and hyperthena areas)
  • CRPs (exaggerated pain response from the nerves)

Post Op Care

  • Day surgery
  • Keep fingers moving, – elevation
  • Debulk bandage at 5 days
  • Review at one week and six weeks
  • Return to desk work at 10 days
  • Return to manual work at one month
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