What is carpal tunnel syndrome?
Carpal tunnel syndrome refers to pain, tingling, or numbness in one or both hands resulting from compression of the median nerve at the wrist. These symptoms are frequently worse at night, and often improve by shaking of the hand.

This problem is diagnosed by a combination of clinical assessment and nerve conduction studies.

In some cases, such as during pregnancy, carpal tunnel syndrome may resolve on its own. However in many patients, the problem requires surgery.

How is it treated?
Carpal tunnel syndrome frequently responds to analgesia, the use of a hand splint at night, and the avoidance of aggravating activities, such as the operation of vibrating objects (eg jackhammers).

In cases which do not respond to conservative measures, surgery may be indicated. This operation is performed frequently by neurosurgeons, and is known as a carpal tunnel decompression. It involves making a small incision, or cut, in the palm of the hand, and dividing the band of tissue which is constricting the nerve. This is done usually under local anaesthetic and light sedation and the patient returns home on the same day.

How is the surgery performed?
A week or two before surgery you will have some blood tests to check that your blood is clotting correctly, among other things. You will be admitted to hospital an hour or two before surgery. You should not eat or drink anything for 6 hours before this.

A specialist anaesthetist will give you some light sedation, and your palm will be administered with local anaesthetic. You will have some antiseptic solution painted on your hand, and a small incision will be made in your palm, usually in a skin crease. Using magnification, your surgeon will then carefully divide the tissues which are compressing the nerve. This will take around 20-20 minutes. Once the nerve is lying freely without any constriction, the skin is closed and a dressing applied.

What happens after the operation?
You will have to wear a hand bandage for 4 days (your GP should check your incision at that stage), and should keep your hand elevated for the first 48 hours. The sutures will be removed around 12 days after surgery by your GP or the Precision Neurosurgery Practice Nurse.

You will be able to use your hand in a progressively normal fashion, but should avoid significant repetitive hand movements, direct pressure over the incision, and heavy lifting for at least 3 months.

You will be given more detailed instructions about incision care before your surgery.

Are there any risks?
Like any type of surgery there is always a chance of developing a complication. These risks are low in carpal tunnel surgery.

The most common complications are wound infection (treated with antibiotics) and haematoma (blood clot).

There is a very small risk (less than 1 in 100) of damage to the nerve, which may cause permanent weakness and/or numbness. Another uncommon complication is "bowstringing" of the tendons in the hand, which make require hand therapy and/or further surgery to rectify. Another postoperative problem that sometimes occurs is wound hypertrophy, or thickening. In most cases the tenderness associated with the wound settles down over several months and does not cause any long-term problems.

What are the results of surgery?
Carpal tunnel decompression is successful in the vast majority of patients, and complications occur in a very small minority.