One of the main nerves to the hand (median nerve) is compressed in a tight space in the wrist called the carpal tunnel. This leads to symptoms which may be intermittent but can become more constant with time. Symptoms can include tingling, weakness, numbness, and pain. Mild cases may be managed non operatively but cases which are moderate to severe may need an operation to relieve persistent symptoms. The cause is often unknown but its is more common in females and can be related to pregnancy , arthritis and some medical conditions.

Do I need Nerve Conduction Studies (NCS)?

This is an objective measure of the function of the nerve. It can be a useful baseline test particularly in patients with atypical presentations, recurrent disease and in cases where the nerve compression could be at two levels (Neck and Hand) . Patients do not always need NCS and often I perform carpal tunnel release based on symptoms and signs during clinical examination.

Non Surgical Treatment

Includes anti inflammatory medications (only if advised by your doctor. A wrist splint at night. Steroid injection (usually provides temporary relief)

Surgical Treatment

This is usually performed under local anaesthetic (Awake) as a day case procedure. A 4 to 5 cm incision is made over the palm and the thick ligament that forms the roof of the carpal tunnel is released. This releases the pressure on the nerve. Symptoms may rake a few weeks to improve and if the problem is longstanding they may not completely resolve.

What is the difference between Endoscopic and Open Carpal Tunnel Release ?

Endoscopic carpal tunnel release involves a much shorter incision. Studies have shown that it does have faster recovery however with a higher risk of incomplete release compared to an Open Approach. There is also a higher incidence of nerve injury with the endoscopic approach. Mr Nikkhah favours an Open Carpal Tunnel release in his practice.

When Can I go back to work after Surgery?

It really does depend on the nature of work that you do. For Non-Manual : 1 to 2 weeks but if you are a Heavy Manual worker (e.g Labourer, HGV driver) it may take up to 6 to 10 weeks to get back to work.

What are the Complications that can occur?

Pain

Infection and wound breakdown

Nerve Injury (rare 2% risk)

Continued Weakness - This is usually due to irrepairable nerve damage from prolonged nerve compression.

Painful or raised scar

Recurrence - could mean that the entire ligament hasn’t been divided.

Complex regional Pain Syndrome - About 1 in 20 people after hand surgery. sensitive to hand surgery and their hand may become swollen, painful and stiff after the operation. This problem cannot be predicted, is variable in severity and is principally treated with physiotherapy.

Open Carpal Tunnel Release

Anaesthetic : Local Anaesthetic

Operative time : 15 minutes

Hospital Stay : Day Case

Time off work : 2 weeks ( Depends on Occupation) 

Recovery Time : 2 - 4 weeks