Hand Surgery

Light At The End Of The Tunnel

  • 											Array
        [name] => Dr Tan Soo Heong
        [avatar] => https://thisquarterly.sg/wp-content/uploads/2019/05/Dr-Tan-Soo-Heong-avatar.jpg
        [tiny_avatar] => https://thisquarterly.sg/wp-content/uploads/2018/12/Dr-Tan-Soo-Heong-tiny.jpg
        [address] => Hand, Wrist & Upper Limb Surgery
    3 Mount Elizabeth
    #09-07 Mount Elizabeth Medical Centre
    Singapore 228510
    Tel: 6737 0177
        [id] => 2117
        [doctor_link] => https://thisquarterly.sg/doctors-panel/hand-surgeon/dr-tan-soo-heong/
        [specialization] => Hand Surgeon
        [specialization_id] => 47
        [specialization_link] => https://thisquarterly.sg/doctors_panel/hand-surgeon/
  • June 1, 2019
  • 2 minutes read

What is carpal tunnel syndrome (CTS)?

It occurs when the median nerve at the wrist is compressed. The median nerve runs from the forearm into the hand along the narrow and unyielding carpal tunnel, sharing space with nine tendons and other soft tissues. When any of these swell or increase in volume, the space becomes tighter and the median nerve becomes compressed. This nerve is responsible for feeling to the thumb, index, middle and part of the ring finger. It also controls the muscles surrounding the thumb. So when a patient develops CTS, both the feeling and muscle control of the thumb and fingers will often be affected.

CTS is common in women who are middle aged, but is also common in younger people who use their hands a lot as part of their work or hobbies. In some cases, the compression can be due to the swelling that results from a wrist fracture or a growth in the carpal tunnel. CTS can also be caused by conditions that lead to fluid retention, such as certain diseases, pregnancy, breast-feeding or menopause.

Symptoms of CTS

  1. Do you suffer from tingling or numbness in your hand?
  2. Does this sensation occur in your thumb, index, middle and/or ring fingers?
  3. Does the sensation happen when you are driving, using your phone, or holding a newspaper?
  4. Does the sensation become so intense that it wakes you up from sleep?
  5. Does the sensation extend from your wrist up to your arm?
  6. Have you been experiencing weakness in your hand and dropping things because of it?

If you have answered “yes” to two or more of these questions, you may have carpal tunnel syndrome (CTS). It is important to seek medical attention if these signs and symptoms are persistent and interfere with your normal daily activities and sleep. Untreated, CTS can lead to permanent nerve damage.

Diagnosing CTS

In the early stages, symptoms are intermittent and usually occur during sleep or when the hand is being used. Tingling and numbness are common, or there may be pain or a burning sensation that radiates up the arm and forearm. Prolonged repetitive activities or gripping can aggravate the symptoms, which become more constant throughout the day as the more constant throughout the day as the condition gets more severe. At this stage, loss of feeling in the fingers and thumb can occur, and this signals nerve damage. This is why seeking specialist medical attention is highly recommended in the early stages to prevent progression.

To diagnose CTS, your doctor will do a clinical examination and may order a nerve conduction test. This electrodiagnostic test assesses the severity of the problem and identifies other nerve problems. Your doctor will also screen you for other contributing conditions, such as diabetes, hypothyroidism, a previous wrist fracture, or a growth in the wrist.

When you need surgical treatment

At the early stages of CTS, medication, supplements and a wrist brace have been proven to be effective. Non-steroidal anti-inflammatory medication and steroid injections will be helpful. It is important to identify activities that result in overuse of the hand and limit such activities. At the advanced stage, carpal tunnel release surgery is recommended to prevent permanent nerve damage. When done early, patients can expect normal or near normal return of sensation and muscle function. However, if there is already significant nerve damage, recovery will not be as ideal.

One increasingly popular surgical method that has been proven to be effective is endoscopic surgery. Also called ‘minimally invasive’ carpal tunnel release surgery, it involves making a small incision in the wrist, instead of the larger incision that traditional surgery requires.

Through this incision, a thin endoscope with a camera is inserted and guided under the thick carpal ligament that stretches across the wrist bones. The ligament is then divided through the endoscope, which increases the size of the carpal tunnel and decompresses the median nerve.

The advantages of this method? A smaller incision means less post-operative pain and scarring; more importantly, there is a shorter recovery time. It also avoids having a large sensitive scar in the palm. Gentle hand and wrist exercises are started soon after surgery to prevent stiffness and to allow tendon and nerve gliding. The few — if any — stitches will usually be removed 10–14 days later. The time it takes before resuming normal activities and returning to work will vary with each individual. This decision should be made in consultation with your doctor.

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