Carpal tunnel is a common complaint. If you work at a computer, or are or have recently been pregnant, you may have experienced tingling or numbness in your hand and wrist (that may wake you at night), occasionally punctuated by sharp, piercing pain. Carpal tunnel syndrome is a painful progressive condition caused by compression of the median nerve in the wrist. In severe cases, it causes weakness and loss of muscle at the base of the thumb, along with a loss of feeling in the fingertips.
The median nerve, which supplies feeling to the thumb and the first two fingers, passes through the ‘carpal tunnel’ in the centre of the wrist along with the flexor tendons to the fingers and thumb. The tendons are covered in a soft vascular tissue (Synovium) that acts as a lubricating/gliding layer for the tendons. This tissue can become swollen or inflamed, compressing the only other soft structure in the tunnel: the median nerve (as the tendons are very firm). Pressure on the median nerve blocks the flow of blood (and therefore oxygen), causing a tingling sensation in the fingers.
An associated cause of tingling is direct compression of the nerve by a thickened and tight transverse carpal ligament.. Ignored, this compression may cause irreversible harm, resulting in altered sensation, and permanent thumb muscle weakness, even after removal of the compression. Dividing this transverse carpal ligament is the key to fixing this problem.
Fortunately, the remedy is a simple outpatient surgery that can be performed under local or general anaesthetic.
During surgery: First, an incision is made in the middle of the base of the hand just beyond the wrist skin crease. Once under the skin, the carpal ligament can be divided to allow the carpal tunnel to spring open, making space for the median nerve and restoring blood flow in its artery.
The painful tingling in the fingers stops immediately, though some painkillers will be needed for a day or two after surgery. The skin is usually well healed in two weeks allowing people to start light work again, getting back to heavy work in around 4-6 weeks.