The facts on carpal tunnel syndrome
Carpal tunnel syndrome is becoming increasingly common in today’s digital age. A Mediclinic orthopaedic surgeon explains the causes and treatment of this condition.
Carpal tunnel surgery is one of the most common and successful operations in hand surgery. It is also the cause of most litigation, so you should be sure you have a good hand surgeon, says Dr Grant Biddulph, an orthopaedic surgeon at Mediclinic Morningside. He explains everything you need to know about carpal tunnel syndrome (CTS), a painful condition of the hand and fingers caused by compression of a major nerve where it passes over the carpal (wrist) bones.
Does using digital devices cause or contribute to carpal tunnel syndrome?
It can contribute to CTS symptoms. Over the years many activities and occupations have been identified as exacerbating CTS, including driving, typing and gardening. The use of digital devices such as cellphones and iPads does not in itself cause CTS. However, it is the posture of the wrist during the use of digital devices and the repetitive, fast movements of the fingers that can contribute to the symptoms.
Studies have shown that both wrist flexion and extension (bending up and down) cause an increased pressure in the carpal tunnel, and if prolonged it can cause symptoms such as pins and needles and numbness on the thumb side of the hand. Any job that requires prolonged wrist flexion or extension can exacerbate the symptoms, and vibrating tools have also been implicated in CTS.
How often does CTS become severe enough to require hand surgery?
The percentage of patients who will require surgery is unknown, because many patients will only have mild symptoms and automatically adjust their movements or use splints to manage the condition. It is more likely that only patients who may have a predisposition to CTS will require surgery. However, if you experience these symptoms often you should seek specialist advice.
Are there preventative measures sufferers can employ to avoid surgery?
If the symptoms are only related to certain activities, changing behaviour and adapting one’s environment may alleviate symptoms. For instance, special keyboards that allow neutral wrist positioning, sitting correctly, using wrist splints and regularly stretching and changing position can help. If one has progressed to night symptoms that do not respond to conservative management, surgery may be the only option. If left unchecked for too long, damage to the median nerve may occur.
What is the typical surgical procedure for CTS?
The most common surgical procedure is an open carpal tunnel release. This is done through a small incision of approximately 2-3cm at the base of the palm. The transverse carpal ligament is divided, which releases the pressure on the nerve in the carpal tunnel. The tunnel must be checked for any masses or other pathology that may be present and can be treated.
The operation itself usually takes 10 to 20 minutes, but the patient will be in theatre for 40 to 60 minutes to include the anaesthetic and wake-up time. Keyhole surgery can also be performed using special equipment to cut the transverse ligament from the inside, but this is rarely done because of the high costs of the procedure.
What is the recovery time?
The wound takes 10 to 14 days to heal, after which the sutures can be removed (unless they are dissolvable) and the hand can be used for daily activities. Recovery of the symptoms depends on the duration of the symptoms before surgery. Usually the night pain and numbness will stop immediately, but any sensory loss or motor weakness will take much longer, typically as long as the symptoms were present before surgery.
Initially, no heavy lifting or grasping is allowed to let the skin heal and give the carpal tunnel time to stabilise. As soon as the wound has healed, the hand can be used and washed.
If someone has severe CTS but is pregnant, is surgery avoided?
Due to the hormonal fluctuations that occur during pregnancy, pregnant women may develop CTS. Symptoms are usually temporary because the hormones will return to normal after the pregnancy, and we try to treat the symptoms conservatively.
Sometimes the CTS can become severe and we know the pressure on the nerve is high. This may lead to permanent nerve damage if left untreated for too long. In such cases we would recommend releasing the carpal tunnel during the pregnancy, using one of the procedures described above.