Carpal Tunnel Syndrome
It is a common condition in which there is increased pressure on the median nerve as it passes through a space in the wrist called the Carpal Tunnel.
What is the cause?
History
Compression of the nerve can cause symptoms in the radial side of the hand such as uncomfortable ‘pins & needles’, burning sensations, or numbness and weakness in more severe cases. Occasionally the discomfort may extend from the hand into the forearm, and worsen with some manual activities such as driving or typing. Symptoms classically wake patients from sleep at night.
Examination
Investigations
Differential Diagnosis:
- Cervical radiculopathy/neuropathy
- Double crush phenomenon
- More proximal Median nerve Compression
Special Tests
- Tinel’s Test
- Phalen’s Test
- Durkan’s Test
When to refer:
- Failed non-operative measures (splints/ one injection)
- Permanent or progressive neurological changes
- Severe symptoms
- Doubt over diagnosis
Treatment options
Here are possible treatments for Carpal Tunnel Syndrome
Wrist splints: A wrist splint worn at night can give some relief of mild night-time symptoms by preventing the hand and wrist from adopting positions that put pressure on the nerve.
Cortisone injection: This is a steroid injected into the carpal tunnel used to confirm the diagnosis and to reduce inflammation. It improves symptoms initially in over 60% of patients which may be sufficient to allow the compression to resolve where there is an identifiable cause (e.g. pregnancy or mild trauma). However, only around a third of patients have long-term improvement. The effect of the injection tends to be better in younger patients.
For more severe cases, a Carpal Tunnel Decompression may be recommended. For the majority of patients, most symptoms are reversible. However, if there has been long-standing or severe compression to the nerve, symptoms of numbness and weakness may take longer to resolve, and may not resolve fully.
Carpal Tunnel Decompression:
This can be performed as either an open procedure or an endoscopic (keyhole) technique. In most circumstances an open technique is preferable. This is performed under Local Anaesthetic as a Day Case procedure. Surgery aims to relieve pressure on the Median Nerve by dividing the roof of the carpal tunnel (transverse carpal ligament).