Carpal Tunnel Syndrome - Does this mean surgery?
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is caused when a nerve called the “median nerve” is compressed through a small tunnel at the level of your wrist. This tunnel is called the ‘carpal tunnel’.
You can see the carpal tunnel at the base of the palm
This compression disrupts the flow of nerve impulses, which is why you may experience pins and needles/tingles or numbness in your thumb, index finger, middle finger and sometimes your ring finger. Prolonged compression of the median nerve can result in permanent nerve damage.
Compression of the nerve can be caused by:
Repetitive bending of the wrist forwards and backwards for example when cleaning, answering the phone, when curled up during sleep
Repetitive or constant pressure applied over the carpal tunnel e.g when using gardening tools
Increase in fluid in the carpal tunnel e.g during pregnancy
Change in the structure of your bones at the level of the carpal tunnel e.g osteoarthritis
Conservative Treatment Vs Surgery - What does it involve?
CONSERVATIVE TREATMENT
Involves your therapist fabricating you a custom made thermoplastic splint to keep your wrist in a neutral position to allow the nerve to rest and repair. Keeping your wrist in a neutral position will assist in preventing compression of the nerve allowing it to heal.
A custom thermoplastic splint can help to open up the carpal tunnel to allow the nerve to heal
Alongside this, your therapist will prescribe you nerve specific exercises to help with improving the nerve health.
SURGERY
Involves a small vertical incision into the palm of your hand. A ligament that makes up one side of the tunnel is cut and sewn back on itself on either side to widen the tunnel to allow more space to assist in preventing compression of the median nerve.
Conservative Treatment Vs Surgery - Benefits Vs Risks
There are benefits and risks of the two treatment options explored for Carpal Tunnel Syndrome. Below are highlights of the benefits and risks of each.
Conservative Treatment:
BENEFITS:
Non - invasive treatment
Avoid surgery if able
Do not need to take any anaesthetic
You will not have a wound or scar tissue
The splint will teach you how to complete your daily activities differently (your wrist in good positioning) so that when your therapist weans you out of the splint, you will not compress the nerve like previously
RISKS:
Depending on the level of compression of the nerve and the length of time the nerve has been compressed, conservative treatment may not be successful due to the level of damage to the nerve
Surgery:
BENEFITS:
Do not need to immobilise the wrist for a period of time
Widening of the tunnel will prevent the nerve from being compressed which will reduce the pins and needles and numbness that you experience
RISKS:
Surgery can be invasive
Infection to your wound
Anaesthesia for surgery
Scar tissue may occur if appropriate treatment to break up the scar tissue is not followed or depending on how your body goes with healing and scar tissue
Sensitive scar
Pillar pain - pain on either side of your scar and up into your thumb
Time off work post surgery
Conservative Treatment Vs Surgery - Which is better?
Neither one of the treatment options discussed is better than the other. It is very dependent on the individual client and their needs. Your therapist can complete a thorough assessment to gain a holistic view of your condition including the history, symptoms, your occupation and daily activities, what is important to you, what you want to be able to achieve and your goals. This will allow us to assist in guiding you to choose a treatment option that is most suited to you.