Francois J Duminy

PLASTIC & RECONSTRUCTIVE SURGEON

Carpal Tunnel Syndrome (CTS) is characterised by numbness and pain in the Thumb, Index and Middle Fingers as well as the Thumb-sided half of the Ring Finger. This is the exact sensory distribution of your Median Nerve wcich runs through a tunnel in the middle of the palmar side of your wrist (Wrist = Carpus)

The Median nerve becomes compressed in that tunnel (due to any one of a number of causes). These may range from temporary postural changes to more permanent anatomical changes.

When conservative methods do not result in improvement or cure of the condition, surgery is required. The aim of the surgery is to release the compression by dividing a thick layer of fibrous tissue that crosses the roof of the tunnel (the Transverse Carpal Fascia)

Our own practice has always been as follows:

  • We usually confirm the diagnosis by nerve conduction studies carried out by a Neurologist.
     
  • The Anaesthetist gives conscious sedation and an intravenous local anaesthetic Block (Bier's Block) to numb the forearm and the hand. The Local anaesthetic is kept in place and blood is kept out of the arm by means of a special tourniquet cuff.
     
  • We make a short incision alongside the mid palmar crease (aka "lifeline"). Via this incision, we expose the Median nerve and, while being careful to protect the nerves, we divide the fascial layer until we are sure that the compression has been fully released.
     
  • Any visible bleeding is controlled by Bipolar Diathermy
     
  • The wound is sutured with 7 to 9 small sutures and soft dressings with compression bandages are applied to the hand.
     
  • Pre- and post-operative Physiotherapy is mandatory.
     
  • The patient is encouraged from the beginning to move the hand through a full range and the Physiotherapists and Occupational Therapists help us to maintain that range through the healing process, sometimes by exercise and sometimes by wearing splints at night.
     
  • We usually do only one hand at a time, leaving the other hand free for essential tasks.

 

Benefits experienced by most patients:

1. Improved mobility and function of the hand

2. Recovery of sensation in the fingers (this may be immediate, but it can also take months depending on the severity and duration of the nerve compression before the releasing operation.

3. Recovery of strength in the some of the small muscles in the hand served by the Median Nerve.

Negative Aspects:

1. Pain, swelling and bruising in the first few days requires elevation of the hand

2. Scar, with good Scar Care - usually fades within a few months

3 Sensory recovery can be prolonged to a few months

4. Certain functions of the hand, such as pushing oeself up out of a chair by pressing palm-down on the arm of the chair may be weakened permanently, but this is easily corrected by using a closed fist to push oneself up and it is a small price to pay for the relief of symptoms of CTS

5. Carpal Tunnel Syndrome may recur after a few years, but this is uncommon.

Carpal Tunnel
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