Carpal Tunnel Syndrome Management

Carpal Tunnel is a 3 sided bone cave with one side being covered by the thick carpal tunnel ligament at the base of the palm in the wrist area. This tunnel contains 9 tendons and the median nerve. Increase in pressure in the tunnel affects the median nerve leading to pain, tingling and or weakness in the hand and fingers.

 

Diagnosis

 

Nerve Conduction Studies (NCS). Nerve conduction study is an effective tool to diagnose and also understand the effect on both the sensory and motor (muscle) component of the medial nerve.

 

Treatment

Conservative Management

Physiotherapy and carpal tunnel exercises may help resolve carpal tunnel symptoms in some.

 

Steroid Injection

Steroid injection can help allay the symptoms of the carpal tunnel syndrome. However, there is a risk of recurrence of the symptoms 3-4 months post injection. If it recurs, then surgery is the preferred option.

 

Carpal Tunnel Release Surgery

This can be performed as an open surgery or arthroscopic (keyhole) surgery. It is performed either under local anaethesia injection or under short general anaesthesia. The cut will be around 3 cm long. The transverse carpal ligament is released. Skin is closed and a bulky dressing is applied.

Rehabilitation

Finger movements are encouraged early. Post removal of stitches (around 10 to 14 days), gentle passive stretches of the wrist and active movements are started. By 4 weeks strengthening exercises are started. One can expect back to most of the regular activities by 6 weeks.

The symptoms of carpal tunnel resolve slowly post-surgery over a period of 1 to 3 months. Pain relief occurs early by 2 to 3 weeks. Tingling resolves around 4 to 6 weeks. Muscle strength is the last one to return and takes around 2 to 3 months. In patients with the long standing carpal tunnel symptoms of more than a year, the symptom resolution occurs over a longer period of time and occasionally may remain incomplete.