What is Carpal Tunnel Syndrome ( CTS)It is pressure on, and strangling of, the median nerve at the junction of the palm and wrist. It causes numbness of fingers and weakness of the thumb.
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 in the middle, index and thumb digits is seen. A particular pattern of symptoms is waking up through the night shaking the hand because it has “gone to sleep”. Over time it worsens, and numbness happens intermittently during the day with actions like talking on the phone, reading a book, driving or knitting. Late signs are continuous numbness, and 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 open or endoscopic ( key hole). Open surgery is usually used if there is one hand or side to done. A 2.5 cm incision is made at the base of the palm, and the fibrous roof of the carpal tunnel released, removing pressure from the nerve. 6 to 8 sutures are in place for 10-14 days. Light use can begin immediately. Key hole surgery can be used if two hands need release at the same surgery. 1 cm incisions at the wrist and mid palm allow a release with endoscopic vision from inside the carpal tunnel.
My friend says their operation didn't work? Usually this means they waited too long to get the operation, and they have permanent damage to their median nerve.
How long does it take to recover after surgery? Fluctuating symptoms like night waking go almost immediately. Continuous numbness can take many months to completely resolve. Palm tenderness and grip weakness take a couple of months months to resolve.