Carpal tunnel syndrome
Carpal tunnel syndrome is due to compression of the nerve that crosses the front of your wrist (median nerve). Pressure on the nerve stops it functioning properly. This tends to causes numbness, tingling or loss of sensation in the thumb, index and middle fingers. It can sometimes cause wasting of the thumb muscles as well. Severe compression can cause permanent loss of sensation and wasting of the thumb muscles. If the nerve has been severely compressed or symptoms have been present for a very long time, the nerve may not recover fully after surgery.
Treatment
Activity modification, splinting, anti-inflammatory medication, steroid injections can be used to treat the problem. If the symptoms are severe then surgery is recommended to relive the pressure on the nerve.
Surgery
The operation is performed under a local anaesthetic, the injection is uncomfortable but then the surgery is not then painful. The procedure is carried out with a tourniquet around the arm, which stops the blood flow to the hand, for a short period, while the operation is performed. A small cut is made in the palm of the hand, and the nerve is released. The hand is bandaged so that the thumb and fingers are free to move. The hand should be elevated and fingers mobilised. The bulky dressing can be removed at 5 days, and then the small dressing over the wound is left on until the wound has healed at 2 weeks.
You can drive a car once you are comfortable and have achieved full finger movements, for most people this is between 1-2 weeks. The grip strength of the hand is weaker to start with, but returns to normal by 12 weeks.
Complications are rare but can occur, they include
Nerve damage- nerves can be bruised or damages during the surgery and sometimes can form a painful lump (neuroma)
Infection- any operation can be complicated by infection and this would be treated with antibiotics
Recurrence- scar tissue can reform over the nerve and the operation may need to be repeated.
Scar tenderness- the scar may be tender to touch or slightly lumpy for 6-8 weeks. This can be improved by massaging the area with cream.
Severe pain, stiffness (chronic regional pain syndrome)- a small number of people get a swollen, stiff, painful hand after any hand operation. This cannot be predicted, but taking regular pain relief, elevating and mobilising the hand helps initially and physiotherapy treatment is required.
Recovery
If there was severe muscle wasting or numbness in the fingers before the operation, recovery can be very slow and may take up to a year. In this case, as the nerves recover there can be tingling in the fingers.
Summary
Carpal tunnel syndrome causes numbness in your thumb, index and middle fingers. A carpal tunnel release relieves pressure on the nerve allowing it to recover; it should improve your symptoms and prevent permanent nerve damage.