Carpal Tunnel Syndrome
Carpal Tunnel
Specialist
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Orthopaedic surgeon Dr Oscar Brumby-Rendell skilfully performs both endoscopic and open carpal tunnel release surgery. He will assess your condition and the projected outcome to assist your decision regarding which surgical intervention is best suited for you.
What is Carpal Tunnel Syndrome
This is a common, progressive condition that causes pain, resulting from median nerve compression in the wrist. Carpal tunnel syndrome encompasses a variety of symptoms usually caused by a number of underlying conditions. It is the swelling of the wrist's carpal tunnel that causes pain. Your doctor will investigate potential underlying causes, as numerous medical conditions can lead to carpal tunnel syndrome.
The carpal tunnel connects the wrist and the hand and is a thin, tube-like structure. Under the carpal tunnel are the wrist bones, and above is the transverse carpal ligament. Inside is the median nerve, which provides the third finger, index finger, thumb and half the ring finger with feeling. Tendons also pass within this passageway. When the carpal tunnel becomes swollen, the tendons within constrict or squash the large median nerve, which results in numbness, pain and reduced wrist function.
Symptoms
Make an appointment with your GP if you are experiencing any of the following symptoms:
- Hand weakness
- Hand/wrist pain during the night
- Loss of grip strength
- Pain in the hand/wrist that extends to the shoulder or arm
- No pain in the little finger and half the ring finger
- Intense wrist pain
- Hand/wrist numbness or 'pins and needles'
- Finger tingling, except in the little finger
Causes
The causes of carpal tunnel syndrome are at times unknown; however, the following often lead to the development of this condition:
- Pregnancy, which can lead to fluid retention and swelling
- Wrist fracture, where a bone fragment damages or irritates the tissue
- Arthritis, which can bring inflammation and swelling
- Hand/wrist overuse, specifically with regard to repetitive or unnatural movements. This could include smartphone use, typing, e-sports, gaming, etc.
- Sprains
- Smaller carpal tunnel at birth, increasing the risk of carpal tunnel syndrome development
- Medical conditions such as hormonal imbalance, rheumatoid arthritis, diabetes, hypothyroidism, obesity, overactive pituitary gland, gout, etc.
- Tumour or cyst presence in the canal
Treatments
Non-Surgical Treatments
Generally, non-surgical treatment methods will be advised initially. Such measures include:
- Using a split when sleeping to decrease pain
- Resting the hand affected by overuse injuries
- Swelling reduction through the application of ice packs
- Physiotherapy
- Swelling reduction via corticosteroid injections
- Fluid reduction through diuretic medication, which promotes excretion through urine
- Treatment of other medical conditions
- Ceasing pain-inducing activities
- Using a wrist brace or splint to immobilise the hand and wrist for 4-6 weeks
- Consumption of medicines such as diuretics and nonsteroidal anti-inflammatory drugs
- Specially designed exercises to stretch and strengthen the hand and wrist (only commence after symptoms have diminished)
Dr Brumby-Rendell may recommend surgical intervention if conservative measures have not resolved your symptoms.
Surgical Treatments
Dr Brumby-Rendell will perform a fairly simple operation if he sees that your condition requires surgical intervention. In this surgery, Dr Brumby-Rendell will cut the transverse carpal ligament, which lies above the carpal tunnel. This will release the pressure on the median nerve, which lies below the tunnel. Throughout your recovery period, scar tissue will form, which should prevent pressure build-up on the median nerve.
Minimally invasive, endoscopic (keyhole) measures are usually implemented by Dr Brumby-Rendell, but open methods are used when required. The latter requires a larger incision for surgical site visualisation.
Types of Carpal Tunnel Surgery
Endoscopic Carpal Tunnel Release Surgery
(Keyhole Surgery)
Here, a 10mm cut is created in the wrist, and a thin tube inserts a small camera into the hand. This camera enables Dr Brumby-Rendell to view the workings of the hand and operate on the transverse carpal ligament while ensuring the minimum amount of scarring. This surgery reduces the pressure on the median nerve, which relieves carpal tunnel syndrome symptoms.
Open release
In this surgery, a 25mm cut is made around the palm, which allows the surgical site to be clearly seen, and the transverse carpal ligament is cut. This operation reduces the pressure placed on the median nerve, which relieves carpal tunnel syndrome symptoms. It also allows for the identification of various other medical issues, such as inflammation or ganglion.
Each surgery type has different recovery times, merits and risks. After evaluating all factors of your syndrome, Dr Brumby-Rendell will advise you on the best course of action.
Post-Surgical Recovery
Numbness of the fingers and hand may be experienced immediately post-surgery due to local anaesthesia effects. Shortly after your procedure, you may feel soreness or stiffness in the hand and wrist.
To reduce swelling, many patients must apply ice packs and elevate their hand. However, this is not required of all patients, and Dr Brumby-Rendell will recommend recovery practices before and after your surgery.
A dressing may be required for 2-3 days post-surgery if you underwent an open release procedure. Generally, the dressing covering non-absorbable stitches will be removed 2 weeks after your surgery at a check-up appointment.
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