The carpal tunnel is a passage in the wrist and hand through which a number of tendons which move your fingers and thumb pass. It also contains a major nerve to the hand called the median nerve. This nerve provides the hand with sensation to the thumb, index, middle and half of the ring finger. It also supplies power to the thumb base.
The carpal tunnel is around an inch long and is made up of bones and a ligament. The walls and floor are bone, with the roof being a strong ligament called the transverse carpal ligament.
In some people the ligament becomes thickened and as a result the median nerve becomes compressed. This compression leads to the symptoms of carpal tunnel syndrome.
Reasons for the ligament to thicken include pregnancy, endocrine conditions such as diabetes, manual work, repeated physical activity or simply as a product of progressing through life.
What are the symptoms of carpal tunnel syndrome?
These can be variable, however more common symptoms that may strongly suggest the presence of carpal tunnel syndrome are numbness, pins and needles and weakness in the thumb, index, middle and ring fingers. Clumsiness or loss of dexterity of the hand can also be seen. Symptoms at night which wake you from sleep are common as well as symptoms from long distance driving. More severe or longstanding carpal tunnel syndrome can lead to weakness and wasting of the muscles of the thumb base.
How do you diagnose carpal tunnel syndrome?
The diagnosis is normally made clinically following a medical history and examination. In some cases you may require some nerve tests called neurophysiology or nerve conduction studies, which look at how well the nerve is transmitting information to confirm the diagnosis.
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How do you treat carpal tunnel syndrome?
Non operative treatments include activity avoidance or restriction, the use of splints and injections of steroid and anaesthetic in to the carpal tunnel. This of course is treating the symptoms rather than the cause and there are limits to the effectiveness and duration of non-operative treatment.
The operative option is to perform a carpal tunnel release. In this operation the thickened ligament is divided to relieve the pressure on the median nerve.
The operation is done as a day case procedure under a local anaesthetic and takes around 10 minutes to perform.