Adult
Carpal tunnel syndrome
Median nerve · wrist
What it is
The median nerve passes through the wrist in a narrow space, the carpal tunnel, bounded by the carpal bones and by a thick, unyielding ligament. When pressure rises inside the tunnel, the nerve’s blood supply falls and it stops conducting normally.
It is the most common nerve compression. The risk is higher with diabetes, an underactive thyroid, during pregnancy, and after a wrist fracture.
Symptoms
Numbness and tingling in the thumb, index, middle and half the ring finger. The most characteristic sign is waking at night, relieved by shaking the hand or hanging it out of bed.
Dropping things and difficulty with buttons and keys follow. At an advanced stage the muscle at the base of the thumb wastes and numbness becomes permanent — which is the main argument against waiting indefinitely.
Non-operative treatment
A night splint holding the wrist straight is effective in mild to moderate cases: it is bending the wrist during sleep that raises the pressure most.
Adapting activities and a corticosteroid injection into the tunnel are added; the injection gives relief that is often temporary but useful, and it confirms the diagnosis along the way. Nerve conduction studies grade how severe the compression is.
Surgical treatment
Carpal tunnel release means dividing the ligament that forms the roof of the tunnel, which decompresses the nerve immediately. The ligament does not close back up: its ends heal apart, leaving more room.
It is done as day surgery under local or regional anaesthesia, either open or endoscopically. The operating time itself is short — of the order of a quarter of an hour.
Recovery expectations
The hand is used for light activity immediately and the dressing is reduced after a few days. Night waking often stops within days, which for most people is the most striking change.
Numbness that has been present a long time recovers slowly, over months, and sometimes incompletely. Tenderness in the palm around the scar for two to three months is normal and expected. Heavy gripping usually returns at around four to six weeks.
These pages give general information for patients and referring physicians. They do not replace an individual assessment: the treatment plan is decided in consultation, based on your examination and your goals.