Carpal Tunnel Operation

St Luke’s Surgery
Pinfold Health Centre
Field Road
Bloxwich, Walsall

What is Carpal Tunnel Syndrome (CTS)

A nerve gets trapped at the wrist. It can happen with age and arthritis in the wrist joints, pregnancy, fluid retention, under active thyroid, wrist fractures, and often with no underlying reason.

What are the symptoms

It starts off with an odd ‘pins and needles’ sensation in the thumb, index, middle and part of ring finger. It is often worse at night waking you up. Shaking the hands relieves it and you could go back to sleep. It progresses to pain in the same area but sometimes radiating above wrist. Later it causes muscle weakness in the hand making you drop things. Astute patients will note that the sensation in the fingers are reduced and ‘can’t feel the needle when sewing’

How is it diagnosed

It is often confused with pins and needles of the trapped nerve in the neck in Spondylosis. In spondylosis the symptoms are felt more in the back of the hand whereas in Carpal tunnel it is predominantly in the front of the hand. Holding the wrist forced into a ‘curled up’ position for a minute or two will reproduce the pins and needles. The diagnosis is confirmed by a nerve test which is currently done in the hospital and there is a waiting time.

What treatment options are there

Splints to hold the wrist straight at night (about £15 - 20) and injections (£55) can relieve the pain temporarily and is good enough to tide over a CTS in pregnancy. The definitive treatment is operation to release the trapped nerve

How is the operation done?

The operation used to be done in the hospital under a general anaesthetic with a tourniquet to cut off the blood supply to the wrist temporarily during operation.

With better technique it can be done under a local anaesthetic injection at the wrist and with no painful tourniquet. The operation takes about 30 minutes

What is the time to recovery?

When the local anaesthetic wears off it can be uncomfortable and painkillers taken before the pain starts is a good idea. The pins and needles will usually go away overnight. The skin wound will heal in a week or two, but inside, it takes 6 weeks to heal up. It will be 6 months before the scar becomes completely pain free and supple.

Most people are able to drive and write (and do washing up!) in a week after removal of stitches. Light work can be done in 3 weeks and manual work in 6 weeks. Heavy lifting pulling etc will cause pain at the scar for upto 6 months, but is of no harm.

Once the pain and pins and needles have gone away, one will notice the numbness. The numbness and and any weakness will take 6 to 18 months for full recovery and can be incomplete.

What are the complications

The complication rate is very low, infection and nerve damage occasionally happening. Rarely patients do not get the expected pain relief  and very rarely a condition called regional pain syndrome with increased pain redness and swelling happens with prolonged treatment and recovery.

What are the costs?

The treatment is free on the NHS, see your GP to refer to Primary Care Surgery for evaluation.

Private operation costs £ 450, (injection £55, Splint £20) and can be done in a week. Contact Kate Morral 01922 775136/37/775515.