What is Carpal Tunnel Syndrome (CTS)? It is pressure on, and constriction of, the median nerve where it passes between the palm and wrist. This compression produces numbness and tingling in the affected fingers, along with pain and reduced strength, particularly weakness of the thumb and difficulty with fine hand movements.

Who gets CTS? It is a common problem that gets more common with age. Diabetics are more prone to get it. Pregnant women can also get it towards the end of their pregnancy.

What are the Symptoms? Pins and needles, tingling or numbness, particularly affecting the middle, index and thumb digits, are commonly experienced. A characteristic pattern is waking during the night to shake the hand because it has “gone to sleep.” Over time the condition typically worsens, with numbness occurring intermittently during the day during activities such as holding a phone, reading a book, driving or knitting. In later stages continuous numbness may develop, along with wasting and weakness of the thumb abductor muscle.

What are the differential diagnoses? Numbness of primarily the little finger can be from pressure on the ulnar nerve, or “funny bone” at the elbow. Cervical root compression ( neck pain) can cause similar symptoms.

What tests to do? Nerve conduction studies with electromyography by a neurologist or neurophysiology centre will confirm the diagnosis and grade the severity.

Treatment A night splint, that holds the wrist straight, works well for early and predominantly night time symptoms. A steroid injection into the carpal tunnel can be helpful for short duration onset symptoms, or during pregnancy. Surgery is the best treatment for worsening symptoms. It is most reliable before there is continuous altered feeling or muscle wasting.

Surgery Surgery can be performed as open or endoscopic (keyhole) procedures. Open surgery is usually chosen when only one hand or one side requires treatment. A 2.5 cm incision is made at the base of the palm, and the fibrous roof of the carpal tunnel is carefully released, relieving pressure on the median nerve. Typically 6 to 8 sutures are placed and remain for 10–14 days. Light use of the hand can begin immediately after surgery. Keyhole (endoscopic) surgery may be preferred when both hands need release during the same operation. Small 1 cm incisions are made at the wrist and the mid-palm, allowing the surgeon to visualize and divide the ligament from inside the tunnel using an endoscopic camera. Both open and endoscopic techniques achieve the same overall outcome, and the best option for your situation will be decided in discussion with Dr Hile.

My friend says their operation didn't work? Usually this means they waited too long to have the operation, and as a result they have sustained permanent damage to their median nerve.

How long does it take to recover after surgery? Fluctuating symptoms such as night waking usually settle almost immediately. Persistent, continuous numbness may take many months to fully resolve. Palm tenderness and reduced grip strength typically improve over a couple of months. Most people are able to do light hand use within a few days, return to moderate physical tasks after about three weeks, and resume activities like gardening or golfing after a couple of months.