CARPAL TUNNEL SYNDROME
This is one example of a nerve compression syndrome. Here, a nerve in the hand, which happens to pass through a confined tunnel in the wrist, becomes squashed. Treatment is likely to be curative in most cases with a low chance of recurrence.
These are in the character of a compressed nerve.
Dull aching pain is felt in the hand and wrist, but often spreads up the arm.
Sensation in the fingers is impaired and tingling may be noticed. This causes difficulty doing specific tasks, due to lack of awareness of touch with resultant clumsiness. Work, home activities and hobbies may be affected: often mentioned are, sewing, holding a book or the telephone, together with a tendency to drop crockery.
There is usually variation of symptoms with significant waking at night.
Often there is nothing to find on medical examination of the hand, because in mild and moderate cases the compression is intermittent. In severe cases there may be sensation loss in the territory of the median nerve, and there may be muscle wasting in the thumb.
Other causes of hand problems should be sought.
Mainly, this is made on the character of the patient's history.
Care is taken to consider other possible causes of the symptoms that may be confusing. Sometimes pain of arthritis can express with tingling and numbness, and nerve symptoms can radiate to the hand from further up the limb, even as far as the neck.
In doubtful cases nerve conduction tests are done by a Specialist in Neurophysiology.
Wearing a straight ‘splint' on the wrist at night [only] may relieve symptoms, allowing reasonable sleep.
Steroid injection in the region of the carpal tunnel [but not into the median nerve] often gives temporary benefit.
Improvement from splints and injections is usually temporary but this may help patients over a bad spell, for the condition may change over time.
Surgery to decompress the median nerve relieves symptoms and the disorder. It is done on medium or severe cases that are persistent over a period of months or more, or on severe cases which appear suddenly.
This is done under local anaesthetic as a ‘day-case'. Pain on insertion of the injection is modest, and the surgical procedure will be painless.
The ligament that completes the carpal tunnel is opened. Releasing it causes no harm.
After surgery pain is minimal also. Light use and movement exercise are performed from the day of surgery, allowing essential functions to continue.
Discomfort and weakness is usual following surgery but diminishes progressively, quickly at first, and often continuing for a few months to a minor degree.