Simon Richards

orthopaedic surgeon


your Specialist in conditions


of the arm & hand


Carpal Tunnel Syndrome

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The Median nerve compressed in the Carpal Tunnel

The Median nerve compressed in the Carpal Tunnel

What is it?
The hand is supplied by three main nerves, which give sensation and motion to the hand.
One of these nerves is called the median nerve. It enters the hand through a small tunnel at the front of the wrist called the Carpal Tunnel, the roof of which is made up of a tight ligament. (see diagram).
In Carpal Tunnel Syndrome (CTS), this tunnel becomes narrower due to the ligament becoming thicker. This presses on the median nerve below.
This classically (but not always) causes pins and needles in the thumb, index, middle and part of the ring fingers, and can be especially worse at night. The pain can extend up the arm to the elbow. The hand can also feel weak.

What can be done?
Often nerve tests are carried out to confirm the diagnosis, and to give an idea of how severe the compression is.
On some occasions Carpal Tunnel Syndrome can be treated with an injection of steroid and local anaesthetic, but recurrence often occurs. Splints can be useful to wear at night if the symptoms are mild.
Surgery is the most common way to treat this problem. This involves cutting the thickened ligament to relieve the pressure in the tunnel.
Surgery is usually carried out as a day case and under local anaesthetic. Some of the fingers will be numb for up to ten hours after surgery. As this affect wears off, it may well be worth taking some pain killers. Dissolvable sutures are usually used.

After the operation, you will be in a big bandage, but the fingers will be free to move. It is important to move all fingers and thumb straight away, as well as keeping the hand raised (above the level of your heart) for at least 72 hours to help with swelling and stiffness.
The bulky dressing can be taken down at 4-5 days after surgery, and a light sticky dressing applied to the wound. Occasionally a cast will be applied for 2 weeks, or you will be told to keep the dressings on for 2 weeks.
You will be reviewed in the Orthopaedic clinic at 2 – 6 weeks. Timing of your return to work is variable according to your occupation and you should discuss this with your G.P or Surgeon.

You will have a scar on the palm. This will be firm to touch and tender. This can be helped by massaging the area firmly with a moisturizing cream.

You may find that initially your grip is weak and slightly uncomfortable. This will gradually improve over six months.

Over a period of time, there is always a small risk of recurrence of the symptoms.

Surgery usually removes the pre-operative pins and needles and pain. Any numbness present before the operation can take months to improve, and in some cases can remain permanently.

About 5% of people are sensitive to hand surgery and their hand may become swollen, painful and stiff after an operation (Complex regional pain syndrome). This problem cannot be predicted but will be watched for afterwards and treated with physiotherapy.