Carpal tunnel decompression

If you would like to know about symptoms and diagnosis of carpal tunnel syndrome, and treatment of carpal tunnel syndrome by means of carpal tunnel decompression, the following information will interest you.

If you are considering carpal tunnel surgery (carpal tunnel decompression) or have carpal tunnel surgery planned, it is important to know all you can about it. This includes:

• why you need carpal tunnel surgery

• what it will be like

• how it will affect you

• what risks are involved

• any alternatives.

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when performing carpal tunnel surgery, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your carpal tunnel treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

You have a squashed or compressed nerve in your hand. This is giving you pins and needles, and possibly pain, in your fingers. This condition is called carpal tunnel syndrome. The name of the nerve involved is the median nerve. Symptoms include:

• Tingling, burning, or numbness, especially in the thumb and index or middle fingers.
• Pain or numbness that is worse with hand or finger movements, or wakes you at night.
• Hand stiffness or cramping that improves by shaking your hand.
• Weakness or clumsiness in your grip.
• Pain that moves up your arm.

If your nerve is severely squashed the muscles it controls can shrivel over time.

What is the median nerve?

The median nerve supplies sensation from the palm side of the thumb, index and middle fingers, and half of the ring finger. It also controls a muscle at the base of the thumb. The median nerve runs through a tunnel, called the carpal tunnel, in the palm of your hand; hence the name carpal tunnel decompression.

What has gone wrong?

There is not quite enough room for your nerve in its tunnel. Although in many cases there is no obvious reason, carpal tunnel syndrome may arise from:

• repetitive movements of your hand or wrist
• using vibrating equipment or tools
• having a narrow carpal tunnel. This may run in your family
• previous wrist injury
• certain diseases, such as diabetes, arthritis and Raynaud’s disease
• fluid retention from being pregnant or because of heart, kidney or thyroid problems
• taking medicines, such as the contraceptive pill or drugs for high blood pressure
• hormone-related conditions, such as pregnancy, the menopause and excess growth hormone.

The aims

The aim of a carpal tunnel decompression operation is to relieve the pressure on your median nerve. We do this by opening the ‘roof’ of your carpal tunnel to give your nerve more space.

The benefits

Releasing the nerve should stop most, if not all, of your symptoms.

Are there any alternative treatments?

If your symptoms are mild you can try wearing a wrist splint. Another thing to try is having a steroid injection into the wrist. Some surgeons do keyhole surgery instead of open surgery.  However there is no evidence that the results are any better. The complications are greater than with open surgery.

What if you do nothing?

If your nerve is squashed and you do not have an operation, your symptoms will probably get worse. Over time your nerve can be permanently damaged. In severe cases the muscles controlled by the nerve can shrivel.

Who should have it done?

If you have carpal tunnel syndrome and the symptoms interfere with your daily activities and possibly disturb your sleep, you should have the operation.

Who should not have it done?

You should not have a general anaesthetic, where you are unconscious for the operation, if you have major medical problems, such as high blood pressure or a bad heart. However, as this is a minor operation, there are no real problems in having it under a local or regional anaesthetic, where only part of the body is numbed. This is commonly done.

Pregnancy - if you only suffer carpal tunnel symptoms while pregnant, you should not have this operation, as the symptoms may go once you deliver your baby.

Author: Mr Boyd Goldie MBBS FRCS BSC DHMSA. Consultant in orthopaedics & trauma.

© Dumas Ltd 2006

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