Carpal Tunnel Syndrome Information for patients Therapy Services Phone no: 01625 661481 www.eastcheshire.nhs.uk @eastcheshirenhs Ref: 11437 Review: 06/2015 Carpal Tunnel Syndrome Ref: 11437 Page 1 Review: 07/2015
What is carpal tunnel syndrome? Carpal tunnel syndrome is a condition where pressure on one of the main nerves to the hand (the Median nerve) causes uncomfortable pins and needles sensations in the hand and in more severe cases, numbness and weakness in the hand. The nerve passes through a tunnel from the wrist to the hand. The tunnel has a bony floor and sides but the roof of the tunnel is formed by a strong ligament (the transverse carpal ligament). What causes it? In the majority of cases there is no known cause and it seems that it occurs because of individual reasons and often runs in families. However, it is recognised that there are a number of conditions which may cause the onset of symptoms. Pressure on the nerve in the carpal tunnel can occur because of a narrow tunnel, thickening and tightening of the ligament across the tunnel (the transverse carpal ligament), swelling of the soft-tissue contents of the tunnel (due to trauma or rheumatic causes), injury to the bones forming the margins of the tunnel, or generalised hormonal changes such as in pregnancy, the menopause or thyroid disorders. There are also some other conditions such as diabetes and cervical spondylosis (arthritis of the neck), which are associated with an increased occurrence of carpal tunnel syndrome. Symptoms: Patients (most commonly 30-50 years of age) frequently first notice uncomfortable pins and needles sensations in the hand which wake them at night. This may also occur with some manual activities during the day. There may be numbness in part of the hand (supplied by the Median nerve) and this may be intermittent or, in the most severe cases, constant and may also be accompanied by weakness of some of the muscles in the hand. Occasionally the discomfort may extend beyond the hand into the forearm. Carpal Tunnel Syndrome Ref: 11437 Page 2 Review: 07/2015
Diagnosis: The diagnosis can often be made from the clinical history and by a clinical examination without requiring special tests. If needed, electrical tests (nerve conduction studies) are a useful investigation which can show slowing in the speed of conduction in the nerve at the site of compression. What treatments are available? In some situations, such as pregnancy, no operation is required as the condition may settle on its own once the hormonal changes have resolved after delivery of the baby. In most cases some form of treatment is required. Some relief of night-time discomfort may be achieved with the use of wrist splints at night. A cortisone injection can give some relief but will only often have a temporary effect. It is therefore not used routinely but may be used on occasions as a diagnostic test if the diagnosis is not entirely clear, or to give relief in the last 3 months of pregnancy. Surgery involves relieving the pressure on the nerve by dividing the transverse carpal ligament and releasing the Median nerve. This is usually carried out as a day case under local anaesthetic (you are awake for the procedure) administered by injection at the wrist. The incision is approximately 3-4 cms in length and is stitched at the end of the procedure. The hand is bandaged and you are encouraged to elevate the hand to prevent swelling and throbbing for the first 24-48 hours after the operation. What should I expect after the operation? You will be given some pain-relieving medication to take if the pain is troublesome. Arrangements are made for you to be seen in the outpatient clinic for removal of the stitches 2 weeks later. During this time the wound should be kept clean and dry. Driving You should allow a period of approximately 2 weeks before driving and will need to be collected from hospital after the operation. Carpal Tunnel Syndrome Ref: 11437 Page 3 Review: 07/2015
Time off work Your return to work will depend on your job. Light manual workers can return to duty in 2-3 weeks Heavy manual workers should not exert maximal grip for 6 weeks. What are the risks, consequences and alternatives associated with surgery? If there is a long-standing compression of the median nerve there may be irreversible changes of numbness and/or weakness in the hand. However, in the majority of cases the changes are reversible and after surgery the unpleasant night-time discomfort resolves rapidly. If there is a numbness and weakness this will take longer to resolve and in some cases does not resolve completely. Sometimes, as the numbness in the hand recovers there can be a period of time where there is over-sensitivity of the affected area before the feeling returns to a more normal level. A small percentage of patients will develop a severe reaction after hand surgery, with lifelong permanent pain and stiffness which is unresponsive to treatment. Specific risks of carpal tunnel decompression are: Injury to the median nerve. Recurrence of carpal tunnel syndrome (approximately 10%) Tender scar. It will take about 6 8 weeks or more for the scar sensitivity to gradually resolve. Contact Details If you are concerned about any of these risks, or have any further queries, please speak to your consultant. Secretary Contact Numbers: Mr Bassi 01625 661095 Mr Waseem 01625 661315 Mr Fischer 01625 661095 Carpal Tunnel Syndrome Ref: 11437 Page 4 Review: 07/2015
References: Title: A systematic review of conservative treatment of carpal tunnel syndrome Author(s) Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, Rabini A, Piantelli S, Padua L Citation: Clinical Rehabilitation, 01 April 2007, vol./is. 21/4; (299-314) Title: Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review Author(s) Shi Q, MacDermid JC Citation: Journal of Orthopaedic Surgery, 2011, vol./is. 6/; (17) Comments, compliments or complaints We welcome any suggestions you have about the quality of our care and our services. Contact us: Freephone: 0800 1613997 Phone: 01625 661449 Textphone: 01625 663723 Customer Care, Reception, Macclesfield District General Hospital, Victoria Road, SK10 3BL For large print, audio, Braille version or translation contact Communications and Engagement on 0800 195 494. Admission information The trust accepts no responsibility for the loss of, or damage to, personal property of any kind, in whatever way the loss or damage may occur, unless deposited for safe custody. Please leave valuables at home. If you need to bring personal items that are expensive, for example micro hearing aids, please be aware that you do so at your own risk East Cheshire NHS Trust is committed to ensuring that patients and staff will always be treated with dignity and respect. There will be no age, disability, gender, race, sexual orientation or religious discrimination NHS Direct (part of NHS Choices) is a 24 hr phone advice service providing confidential health advice and information. Phone: 0845 4647 (Textphone 0845 606 46 47) www.nhs.uk Carpal Tunnel Syndrome Ref: 11437 Page 5 Review: 07/2015