Carpal Tunnel

 

Carpal Tunnel
Syndrome, Treatment & Recovery

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.

Carpal Tunnel Syndrome is not a single condition. Rather, it is a collection of symptoms commonly caused by other underlying conditions. In simple terms, swelling inside the narrow carpal tunnel in the wrist is the cause of the pain. A variety of conditions contribute to carpal tunnel syndrome so your doctor will usually look for underlying causes.

The Carpal Tunnel is a narrow passageway between the wrist and the hand. The wrist bones lie underneath it and the transverse carpal ligament sits over the top. Inside the carpal tunnel is the median nerve, which gives feeling to the thumb, index finger, third finger and half of the ring finger. Several tendons also pass through this narrow space. When swelling occurs, these tendons squash or constrict the large median nerve. Symptoms of numbness and pain and reduced function are the result.

 

Symptoms of Carpal Tunnel Syndrome

If you have any of the following symptoms of Carpal Tunnel Syndrome, it's a good idea to make an appointment.  Early intervention often means treatment is more effective.

Symptoms of Carpal Tunnel Syndrome

If you have any of the following symptoms of Carpal Tunnel Syndrome, it's a good idea to make an appointment.  Early intervention often means treatment is more effective.

  • Weakness in your hand.
  • You suffer pain at night.
  • Diminished grip strength.
  • You have pain that radiates into your arm or shoulder.
  • Your little finger and half of your ring finger are not affected by pain or weakness.
  • You have stabbing pain in your wrist.
  • You experience numbness or pins and needles in your wrist or hand.
  • Tingling sensation in all the fingers except little finger.

Causes of Carpal Tunnel Syndrome

While sometimes the cause of Carpal Tunnel Syndrome remains a mystery, the following conditions are common causes:

  • Pregnancy can cause fluid retention which leads to swelling.
  • Arthritis often causes swelling and inflammation.
  • Wrist fracture, when a fragment of bone irritates surrounding tissue.
  • Overuse of the hand or wrist, especially when using awkward or repetitive movements.
  • Some people were born with a smaller carpal tunnel, making them more prone to problems.
  • Sprains.
  • Hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland.
  • Presence of a cyst or tumour in the canal.

Treatment for Carpal Tunnel Syndrome

In most cases, non-surgical treatments will be recommended before considering surgery.  These can include:

  • Wearing a splint at night to help with the pain.
  • Resting your hand and wrist if the injury is caused by overuse.
  • Physiotherapy treatments.
  • Corticosteroid injections to reduce the swelling.
  • Diuretic medication which reduces fluid in your body by excreting it as urine.
  • Treating underlying medical conditions.
  • Immobilization of the hand and wrist with a splint or wrist brace for 4-6 weeks.
  • Ice packs to avoid swelling.
  • Avoid activities that tend to worsen the symptoms.
  • Medications such as nonsteroidal anti-inflammatory drugs, diuretics.
  • Strengthening and stretching exercises once symptoms dimish.

If conservative treatment options fail to resolve the condition your surgeon may recommend a surgical procedure.

Carpal Tunnel Surgery and Recovery

When surgery is the best option, Dr McLean will perform a relatively simple operation.  It involves cutting the transverse carpal ligament over the top of the carpal tunnel, which relieves pressure on the median nerve below.  As your body heals the injury to the ligament, scar tissue forms which should prevent the buildup of pressure on the nerve.

Dr McLean prefers to manage carpal tunnel syndrome using a minimally-invasive, key-hole endoscopic surgical technique (when indicated).  An open technique can also be used and involves a slightly larger incision and clear visualisation of the structures inside the carpal tunnel.  For more information about driving after carpal tunnel surgery, read this guide.

Types of Carpal Tunnel Surgery

Endoscopic Carpal Tunnel Release Surgery

In this method, a small cut (10mm) is made in the wrist, and a tiny camera is guided through a thin tube into the hand.  This allows Dr McLean to investigate the mechanics of the hand and cut the transverse carpal ligament with minimal scarring.  This relieves the pressure on the median nerve to alleviate symptoms of carpal tunnel syndrome.

Open release

This involves a 30mm incision in the palm area, which allows Dr McLean to visualise the contents of the carpal tunnel as well as carefully cut the transverse carpal ligament.  This relieves the pressure on the median nerve to alleviate symptoms of carpal tunnel syndrome and allows visualisation and attention to any coexisting problems (such as ganglions or inflammation) at the same time.

The type of surgery you have may influence your recovery time.  Each type has its merits and risks.  Dr McLean can make a recommendation after consideration of all the factors relating to your condition.

What to expect after carpal tunnel surgery

Immediately after surgery, you may feel some numbness in your hand and fingers. This is due to the lasting effects of local anaesthesia. As it wears off, you may feel some stiffness and soreness.

You may need to keep your hand elevated and apply ice packs to reduce swelling. This is not the case for all patients. Dr McLean will explain his findings at the time of surgery and recommend whether this is appropriate for you.

If you have open release surgery, you may need a bulky dressing for 2-3 days afterwards. This is normally removed and the non-absorbable stitches will be covered by a dressing that will be removed at your 2-week follow-up after your operation.

After Carpal Tunnel Syndrome

  • Elevate the hand above heart level to reduce swelling.
  • A splint may be worn.
  • Ice packs to the surgical area to reduce swelling.
  • Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
  • Physical therapy may be ordered to restore wrist strength.
  • Eating a healthy diet and not smoking will promote healing.

You will need to restrict the use of your arm, especially for strenuous activities so that it has a chance to recover without additional damage. Dr Mclean will advise you about these restrictions.

Returning to work after carpal tunnel surgery

When you can return to work depends on the type of surgery you had, whether the surgery was on your dominant hand, and the type of work activities you use your hands for.

For example, if you had endoscopic surgery on your non-dominant hand, and you only perform very light actions at work, you might return to work in 7 to 14 days.

However, if you had open release surgery on your dominant hand, and do repeated actions at work such as typing or manual labour, you may be off work for 6 to 8 weeks.
Dr McLean normally recommends 2 weeks off of work and re-evaluation at the 2-week follow-up after your operation. Dr McLean will re-assess you then and provide further recommendations.

Pain after carpal tunnel surgery

The majority of patients suffer no complications following carpal tunnel release surgery. However some patients may suffer from pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.

Pain after surgery is normal and part of the post-operative recovery. For those who do experience pain or weakness, it can resolve itself anywhere between a few days to a few months after surgery.

Over the counter medicines such as Ibuprofen may help reduce pain and inflammation. Dr McLean may prescribe you any stronger pain medications after a post-surgery assessment.

Carpal tunnel exercises

Dr McLean routinely prescribes "Dr McLean’s 6-pack hand exercises". An information sheet demonstrating these exercises will be provided post-operatively by Dr McLean.

Driving after Carpal Tunnel Surgery

It is likely you will not be able to drive for 1 to 2 weeks after surgery. This is because you may experience some sensitivity or pain in the first weeks, which can hinder your ability to safely drive a car.

It is sensible to wait until your wound has healed to prevent your stitches from loosening and your wound opening. This usually takes 10-14 days. Most people are able to begin gentle driving approximately two weeks after their carpal tunnel surgery.

Your readiness to return to driving is dependent on your individual case – please speak to Dr McLean for a professional assessment prior to driving and to avoid disappointment.

Self-care after carpal tunnel surgery

It is wise to have a pre-planned mode of transportation to get home after your surgery. Ask a friend to assist, devise a public transport route, or set aside funds for a taxi. Plan your activities with the awareness that you will also need to:

Returning to safe driving

It is important that your hand/s are healed enough for you to control your vehicle under any conditions, especially an emergency situation.

Take the following into consideration before you attempt to drive:

  • What type of car you drive (manual, power steering)
  • Driving conditions (bad weather, poor light)
  • Your journey length (longer trips may fatigue your hands)
  • Any pain you are experiencing
  • Motor function in your hand/s
  • Your mental capacity to drive (lucid, medicated or distracted by pain)

A sensible rule of thumb is to first test your ability to drive in a safe environment such as an empty car park. If you can safely and repeatedly perform all emergency stop procedures and maneuvers driving requires, you may consider returning to driving.

Car insurance considerations

Your regular car insurance may not cover you if you have had recent surgery, and/or are taking pain medication. Contact your insurer to discuss your policy conditions before getting into the driver’s seat.

Car insurance considerations

You will likely be taking pain relief medications similar to sedatives after your operation. These medications can interfere with your ability to concentrate, your judgement, and your reaction time. DO NOT drive while you are taking these medications for your safety and that of other drivers on the road with you.

 

Flying after Carpal Tunnel Surgery

Generally you will need to wait 24 hours after your surgery before flying. However, there are a number of factors to consider before booking your flight. Make sure you consider the following:

Airline regulations

Each airline has its own regulations about flying after surgery. Make sure you enquire with them and have any necessary paperwork organised before your flight.  See our Flying after surgery page for more information on selected airlines and their medical clearance requirements.

Discomfort

Especially if you are traveling alone, you won’t be able to carry bags and do some things you typically use your hands for. Transiting through the airport, managing tickets, and other simple activities may be more difficult.

Medical follow-up

You will need to see Dr McLean for a post-operative assessment and to get your stitches out 10-14 days after surgery.

Pain medication

Dr McLean will prescribe pain medication after your surgery. He may also recommend medication to reduce the risk of blood clots, or antibiotics to decrease the risk of infection.

It is a good idea to travel with a copy of your prescription and a letter from your doctor detailing the type of medication you are taking, and the reason for your prescription.

Travel insurance

Your surgery may affect your travel insurance. Check your policy carefully, and contact your insurance provider for advice on whether you will be covered for potential post-surgery issues while you are away.