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Plastic and Hand Surgery Plastic and Hand Surgery Plastic and Hand Surgery

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Carpal Tunnel Syndrome

This is a common hand condition in which patients can experience pain, pins and needles, numbness and weakness of grip affecting one or both hands. The hand itself may be painful and the pain may also be felt in the forearm.

Often patients report that the symptoms are worse when holding a newspaper or driving. Sometimes it can cause discomfort at night typically resulting in a person having to shake their arm or hold it over the side of the bed to relieve their symptoms.

What is the cause of carpal tunnel syndrome?

One of the main nerves in the hand is the Median nerve. It passes through a tunnel of fibrous tissue at the wrist. Any increase of pressure on this nerve can cause the nerve to become irritable and provoke symptoms.

In the majority of cases there is no known cause for carpal tunnel syndrome. There is however an association with pregnancy, rheumatoid arthritis, diabetes, thyroid disease and trauma or injury to the wrist.

What are nerve conduction studies and are they painful?

The diagnosis of carpal tunnel syndrome is usually made on the history and clinical findings. Sometimes electrical tests can be useful in determining the site and severity of nerve compression.

Most patients are able to tolerate the test but some report a degree of discomfort.

What treatment is available?

Treatment depends on the underlying cause. Carpal tunnel syndrome during pregnancy usually settles after delivery and can be managed conservatively.

Treatment of carpal tunnel syndrome may include splints, steroid injection into the mouth of the carpal tunnel or surgical decompression.

Surgical treatment of carpal tunnel syndrome

This is a procedure that can be performed as a day case operation under a local anaesthetic. The tight roof of the carpal tunnel is released relieving the pressure on the median nerve. Stitches are required to close the wound which is about 3cm to 4cm in length.

These are removed after 2 weeks. The hand is placed in a padded bandage with the fingers and thumb free. The hand should be rested and elevated after the procedure and gentle mobilisation of the fingers and thumb is encouraged.

Return to work after carpal tunnel decompression

This depends on the nature of your job. Light duties can be resumed at 2 to 3 weeks. Heavier manual tasks would usually require about 6 weeks before maximal grip can be exerted.

Risks

If there has been longstanding severe compression of the median nerve, numbness and weakness may persist even after surgery.

Specific risks include recurrence of symptoms (approximately 10%), occasionally scar tenderness and sensitivity, rarely bleeding or infection. Median nerve injury is extremely rare but has been reported in the published literature.

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Contact Miss Mary O’Brien for more information on Cosmetic or Hand Surgery.

The British Association of Aesthetic Plastic Surgeons
The Royal College of Surgeons of England Bapras The British Society for Surgery of the Hand

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