Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumatized.

Carpal tunnel syndrome is due to compression of the median nerve within a tunnel comprising a "U" shaped collection of bones with a tight ligament at the top. The most common cause is tenosynovitis.  The nerve can gradually develop permanent damage if the condition is not treated. This causes permanent loss of sensation and wasting of thumb muscles, which cannot be completely relieved by surgery.

What are the symptoms of carpal tunnel syndrome?

Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.

Treatment Options

There are a number of ways of treating the condition including activity modification, splinting, anti-inflammatory drugs, steroid injections and surgery. Surgery is recommended if you have had the problem for a long time, your symptoms are severe, non-surgical treatments have failed or if the doctor detects wasting of muscles or loss of sensation in the hand. Surgery involves cutting the ligament over the tunnel to relieve the pressure on the nerve. This can be achieved in two ways:

Open technique A cut is made in the palm and the carpal ligament is reached by cutting through the underlying tissues and muscle. The ligament then is cut under direct vision.

Endoscopic technique The carpal ligament to be reached from a small cut at the wrist. The ligament is seen using a small telescope, which provides a magnified image on a television screen that the surgeon watches whilst performing the surgery.

ECTR causes a smaller scar in a less sensitive area and it allows the surgeon to be more selective as to which tissues are cut. It therefore shortens the time taken for patients to get back to normal activities. This advantage is most evident in patients who undergo release of both sides together. Complications can occur with either technique.

Post-operative care

My patients have a small bandage postoperatively, which is just change to a Band-Aid on the fourth or fifth postoperative day.  Finger range of motion is started immediately and wrist motion is started gradually.  Sutures are removed between 10 and 12 days postoperatively, in the office.  Usually, therapy is not necessary.  The endoscopic approach, normal activities can be achieved within a few days to a few weeks.  Full return to work can be within two to four weeks depending on work requirements.