Orthopaedics & Sports Medicine

What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition caused by compression of the median nerve as it passes through the carpal tunnel — a narrow passageway in the wrist formed by bones and ligaments. This tunnel also contains nine tendons that help move the fingers. 

When pressure builds up within the carpal tunnel, it can compress the median nerve, leading to a range of symptoms. 

Symptoms and signs
Patients may feel numbness, tingling, and pain in the hand, and fingers. Usually, the three fingers on the thumb side are affected. Symptoms are often worse at midnight and can wake the patient. When it is severe enough, the thumb ball muscles will become wasted. 

Causes
Increase in pressure within the carpal tunnel can happen several ways: 

1. Water retention due to body hormone disturbances. This situation occurs most commonly in ladies of the perimenopausal period. Other causes include pregnancy and low thyroid function
2. Fractures and dislocations around the wrist joint
3. Arthritis including rheumatoid arthritis and gouty arthritis
4. Overuse of the wrist and fingers leading to swelling of the lining of the flexor tendons, called tenosynovitis 
    

Methods of treatment 

1. In less serious cases:
   • Rest and avoid overuse of the hand and wrist
   • Use a splint and keep the wrist in a neutral position
   • Steroid injection, if indicated, can help
2. When the above methods do not work:
   • Surgical decompression of the median nerve becomes necessary. 
      

Carpal tunnel release surgery
The operation is performed under either regional or general anaesthesia. During the procedure, the ligament that is compressing the median nerve is released. 

Nowadays, a minimally invasive technique can be used, involving a small incision at the wrist and the use of endoscopic instruments. This method generally provides effective symptom relief, results in a smaller scar and allows for a quicker recovery. 

However, if the wrist is significantly deformed or the tendon sheaths are markedly thickened, the traditional open method may be required. This involves making an incision across the wrist to allow better access to the affected structures. 

Possible complications:

• Infection in the wound or delayed healing
• Soreness around the incision may last for several weeks or months
• Recurrence of the symptoms
• Damage to the median nerve or the branches of it