Carpal tunnel syndrome occurs when there is compression of the median nerve at the wrist. This nerve runs from the forearm to the palm of the hand. The exact cause is not known, but certain factors such as congenital abnormalities, trauma, rheumatoid arthritis, obesity and pregnancy increase the risk of developing carpal tunnel syndrome. Symptoms of carpal tunnel syndrome usually develop gradually.
The most common ones are:
- Frequent tingling in the thumb, index and middle and ring fingers
- Burning or numb sensations occurring in the palm or fingers and thumb
- Waking up at night having to shake your hand to relieve numbness
- Difficulty grasping things in activities of daily living
Carpal tunnel syndrome is diagnosed by taking a detailed history and conducting a thorough examination. A nerve conduction study is often requested and you will be required to see a neurologist if this is the case. Electrodes are placed on your hand and wrist and a small electric current measure how fast a signal passes through the nerve that is affected.
If your carpal tunnel syndrome is mild and you choose a non-surgical treatment, there are a variety of treatment options. Some of the techniques we can employ are:
Splinting, to prevent the affected wrist from bending, especially at night.
Hand and finger exercises.
Advice on ways to use your hand so as to reduce pressure on the nerve.
Injection of a corticosteroid to reduce inflammation, shrink swollen tissues and relieve pressure on the median nerve. This often works well on pregnant women, providing relief until they give birth at which time symptoms often resolve.
Surgery for carpal tunnel syndrome is known as a carpal tunnel release. The procedure is performed under a general anaesthetic (more common) or under sedation with a local anaesthetic as a day case.
A short incision, only a few centimetres long, is made in the palm of your hand. The ligament that forms the roof of the carpal tunnel is identified and cut through to create more room in the tunnel. Once this is done, your surgeon will suture up the incision and apply a bandage around your palm and wrist, leaving your fingers and thumbs free.
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Following a carpal tunnel release, you will usually be able to go home that day. Your hand will be bandaged, and you will have to keep the hand dry for approximately a week. The operation typically results in minimal pain which can easily be controlled with simple analgesia. In most cases the sutures are self-dissolving but if permanent sutures are used they will need to be removed around day 10-14.
You will be unable to drive for a week following the surgery. Your return to work and usual activities will be entirely dependent on the nature of your work, and this may take up to 4 weeks. It can take up to a year to heal completely.
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Dr Rohit Kumar is an Australian trained and fully certified cosmetic plastic and reconstructive surgeon.
Dr Kumar completed his Bachelor of Medicine and Bachelor of Surgery (MBBS) degree in 1995 at the University of Queensland. He subsequently went on to successfully complete a Masters Degree in the field of Burns Surgery in 2004 – MMedSci (Burns)
His advanced surgical training commenced in the specialty of General Surgery in which he trained for four years. This gave him a solid foundation of technical knowledge and surgical perspective upon which he then built his considerable skills, once he commenced his advanced training in Plastic and Reconstructive Surgery. The Australasian training scheme in Plastic and Reconstructive Surgery is one of the most thorough and rigorous in the world and upon successful completion of this training, over a period of ten years, Dr Kumar was awarded his Fellowship in Plastic and Reconstructive Surgery – FRACS (Plas).
He thus brings over 15 years of surgical experience to his practice having been involved in over ten thousand procedures in that time.
If you require a carpal tunnel release, then it is important that you are informed of the potential risks, complications and side effects of this surgery.
While all care is taken to minimise or totally avoid these complications and side effects, complications may and do occur despite the best medical care. It is important that you carefully read and understand the risk factors and they will be discussed in more detail when you have your consultation with your surgeon.
The Risks include…
- Median nerve injury
- Damage to surrounding tissue
- Pain in the wrist and hand
- Tenderness around the scar