insideKENT Magazine Issue 116 - December 2021 | Page 150

HEALTH + WELLNESS

CARPAL TUNNEL SYNDROME

BY PROF . BIJAYENDRA SINGH , ORTHOPAEDIC SURGEON
What is Carpal Tunnel Syndrome ( CTS )?
Carpal Tunnel Syndrome is a common condition caused by compression of the median nerve as it passes through a tunnel as it crosses into the hand .
What are the causes of CTS ?
The median nerve is trapped in front of the wrist . Normally the nerve and the tendons bending the fingers pass through a tunnel across the front of the wrist . The roof of the tunnel is made of a tight and thick fibrous ligament . Pressure on the nerve can happen several ways : swelling of the lining of the fflexor tendons ( called tenosynovitis ), joint dislocations , fractures , and arthritis .
Causes include :
• Fluid retention during pregnancy , which can cause swelling in the tunnel and symptoms of carpal tunnel syndrome , this often goes away after delivery .
• Thyroid conditions .
• Rheumatoid arthritis and diabetes can also be associated with carpal tunnel syndrome .
What are the symptoms of CTS ?
Typically , patients present with pins and needles in the hand , usually affecting the thumb , index and middle fingers . These are usually worse at night , driving , or holding a book for a long period of time . The symptoms are often relieved by shaking of the hand . Permanent numbness and wasting of muscle are present in later stages of the condition .
What happens if nothing is done ?
Most people develop gradually increasing symptoms over months to years . If left for too long , permanent numbness , muscle weakness and wasting can occur . This reduces hand function considerably .
Diagnosis :
• Diagnosis is usually made by undertaking a detailed history and examination of the whole arm including neck .
• Nerves are like ‘ electrical cables ’ that travel through your body carrying messages between your brain and muscles . Nerve Conduction Studies ( NCS / EMG ) may be used to identify where it is being compressed .
• An MRI of the neck may be requested to rule out a spine problem mimicking CTS .
Non-Operative Treatment :
• These include activity modification , splints and non-steroidal anti-inflammatory medications . The splint is mainly worn at night to prevent waking .
• An injection of steroid and local anaesthetic can relieve the symptoms , in most people , at least in the short-term .
• In cases where the clinical picture is unclear a positive response to an injection helps confirm the diagnosis .
Surgical Treatment :
Carpal Tunnel Release ( CTR ) can be performed to give permanent relief of symptoms . Under local anaesthesia injection , the surgeon makes a cut over the front of the wrist . The tight ligament over the nerve is released , so that the median nerve has more space in its tunnel . The skin is then stitched up usually with non-dissolvable sutures . A splash proof dressing and supportive bandage is applied , and the patient ' s arm ( s ) elevated . CTR can be performed on both sides at once . This is a decision between the patient and the surgeon .
Prof . Bijayendra Singh is a consultant orthopaedic surgeon practising at Spire Alexandra Hospital and KIMS Hospital in Kent . For further information or to book an appointment with Prof . Singh visit www . kentorthopaedicpractice . co . uk .
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