Carpal tunnel syndrome
What is carpal tunnel syndrome ?
Carpal tunnel syndrome is the most common peripheral neuropathy.
It is caused by compression of the median nerve at the wrist, where it passes through a narrow tunnel formed by the carpal bones and the transverse carpal ligament. When this tunnel narrows, the nerve is compressed, producing characteristic symptoms: tingling, numbness and pain in the thumb, index finger, middle finger and the thumb-side half of the ring finger, typically worse at night and often waking the patient from sleep.
Carpal tunnel syndrome is more common in women, particularly after the age of 50. It may be associated with repetitive manual activities, pregnancy, diabetes or hypothyroidism.
When is surgery needed ?
Treatment begins with conservative measures: a night splint to keep the wrist in a neutral position and, if needed, a corticosteroid injection into the carpal tunnel. Surgery is recommended when:
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symptoms persist despite conservative treatment
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there is weakness or muscle wasting at the base of the thumb (thenar atrophy)
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nerve conduction studies confirm severe median nerve compression
How is the procedure performed ?
The procedure is performed under local anaesthesia on a day-case basis (the patient goes home the same day). It takes approximately 15 to 20 minutes.
A small incision in the palm of the hand allows the surgeon to divide the transverse carpal ligament, releasing the pressure on the median nerve. The open technique is used, providing excellent direct visualisation of the nerve and surrounding structures.
What is the recovery ?
Tingling and night pain typically resolve quickly after surgery. The hand can be used for simple everyday tasks within the first few days.
Wound care is required for approximately two weeks.
Physiotherapy is not routinely necessary. Return to desk work is possible within one to two weeks, and manual work within four to six weeks.
What are the risks ?
As with any surgical procedure, carpal tunnel release carries a small risk of complications, including:
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wound infection
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injury to the median nerve or one of its branches, potentially causing a numb area
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a tender or hypertrophic scar
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persistence or recurrence of symptoms in longstanding cases with established nerve damage