Carpal Tunnel Decompression
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a compression of the median nerve at the wrist. It is the most common form of entrapment neuropathy.
The carpal tunnel is a narrow passageway at the base of the hand. It houses the median nerve, which runs from the forearm into the palm of the hand. When the tunnel becomes inflamed – often by repetitive movements or arthritis – it can place pressure on the nerve and cause tingling or pain.
How is CTS diagnosed?
An early diagnosis of carpal tunnel syndrome is very important to avoid any permanent nerve damage.
Once your GP suspects carpal tunnel syndrome as the cause of your pain, he or she will refer you to an orthopaedic team to conduct further tests. This will start with a physical examination of your hands, wrists, arms, shoulders and neck.
Your doctor will rule out any other potential causes for the pain, and then follow the physical inspection with X-rays to test for fractures, arthritis, or nerve-damaging diseases such as diabetes.
Once the doctor confirms the suspicion of CTS, they may run specific tests to verify their findings. These tests might include:
- Electrodiagnostic tests – these measure the electrical activity of your muscles and nerves, and can be used to see if there is nerve damage.
- Tinel’s sign test – your doctor will tap lightly on the affected nerve. If the test is positive, you will feel a tingling sensation radiating down your arm.
- Phalen test – also known as the wrist flexion-test. Your doctor will have you rest your elbows on a table and let your wrists fall into a relaxed, bent position. If the test is positive, you will feel tingling or numbness in your fingers within a minute or so.
- Ultrasound or MRI – these can be used to inspect the soft tissues in the wrist. They may show signs of inflammation or swelling.
What are the symptoms of carpal tunnel syndrome?
You will experience some pain, tingling, and numbness in one or both hands. Symptoms tend to be worse at night time.
You may also experience weakness in your affected hand. This can be caused by a loss of strength in the thumb’s pinching muscles, which are also controlled by the median nerve. You may have difficulty opening jars or holding onto objects as a result.
These symptoms usually onset gradually and worsen over time. Although they may seem to come and go at first, they occur more often and for longer periods over time. Without treatment, the symptoms may become constant.
How do you treat carpal tunnel syndrome?
Like many medical conditions, carpal tunnel might resolve itself without treatment. Pregnant women tend to suffer from carpal tunnel entrapment which resolves itself after delivery in most cases.
Carpal tunnel syndrome often reacts favourably to analgesics (pain relieving medications). Avoiding the use of vibrating equipment (such as chainsaws, hand-held grinders, and other power tools) and using a wrist splint might help reduce pain and aid in the recovery process.
If the pain from your carpal tunnel syndrome doesn’t relieve with non-invasive treatments, then carpal tunnel decompression surgery might be recommended.
Carpal tunnel surgery may be performed to decompress the median nerve. It is one of the most common surgeries in Australia. Surgical options may include open release surgery or endoscopic surgery – the best approach for your carpal tunnel treatment will be decided on by Dr Jonathon de Hoog during your consultation.
Carpal tunnel decompression involves cutting the tissue (flexor retinaculum) that is causing the entrapment. As the surgery is normally performed under local anaesthesia, you will be in and out in the same day.
Surgery should provide relief from the pain, prevent further damage to the nerve, and restore the use of your hand.
Outcomes are normally dependent on the condition, symptoms and their severity. In most cases the recovery process is quick, and you should see immediate results.
During the recovery process, you will need to wear a splint to prevent movement and allow the surgical site to rest. Physical therapy may be recommended to help strengthen your wrist and hand.
You will need to see your GP after 10-14 days to remove the stitches from the surgical site. You might also need to see Dr De Hoog 4-6 weeks after your surgery to discuss any recovery plans or concerns.
Contact Aspire Orthopaedics
At Aspire Orthopaedics, Dr Jonathon de Hoog manages orthopaedic conditions from locations across Townsville, Pimlico and Mt. Isa.