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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is the commonest compression neuropathy affecting peripheral nerves in the upper limb. The median nerve, the main sensory nerve in the hand, passes through a short canal at the level of the wrist on its route to providing sensation to the thumb, index, middle and part of the ring fingers. In this canal, the Capal Tunnel, the median nerve may become compressed, and as it does so, its circulation is halted, which in turn prevents the nerve from working. Because the nerve is a sensory one, the impact of losing its function is the perception of tingling pins and needles and numbness. Numbness classically manifests itself as a feeling of deadness and loss of dexterity, which can be expressed as a feeling of awkwardness and a tendency to drop things.

Neglected Carpal Tunnel Syndrome progresses in some patients, so that ultimately the function of the nerve is severely compromised, leading to profound numbness and therefore altered dexterity, but also weakness of the muscles that helped to position the thumb. Complete loss of median nerve function in severe Carpal Tunnel Syndrome is very debilitating and may necessitate more complicated surgical intervention than simple decompression of the nerve.

Some patients, who are troubled only with symptoms at night, may respond very well to splintage and attempts to modify their sleeping posture. The vast majority of patients will fail to recover in the long term with other conservative treatments such as steroid injections and will ultimately require Carpal Tunnel decompression, a minor surgical intervention, typically performed under local anaesthetic on a day case basis, that decompresses the nerve through a short incision made over the proximal palm.

Recovery from Carpal Tunnel symptoms is quick for those patients whose nerves are still functioning well but can be extremely slow for those who present with profound compression and loss of nerve function, in which case it may take over a year for sensation to return. Recovery of grip strength, after Carpal Tunnel decompression, is relatively slow. I warn patients that it will take 3-4 months before their grip feels really strong for activities such as heavy lifting and gardening. Serious complications are rare following Carpal Tunnel decompression, and include infection.