Carpal tunnel syndrome

Wrist surgery - Carpal Tunnel release (local anaesthetic)

Please be aware that the following prices are a guide price. Your final price will be confirmed in writing following your consultation and any necessary diagnostic tests.

Patient pathway	Initial consultation	Diagnostic Investigations	Main treatment	Post discharge care	Guide price
Hospital fees	N/A	Not included	£1,850	Included	£1,850
Consultants fees from*	£200	N/A	Included	Included	£200
Guide price	£2,050

* Includes Anaesthetist fee

In most cases, your symptoms for carpal tunnel syndrome will begin gradually and without any specific cause. Symptoms may come and go at first, but as the condition worsens, it is possible that your discomfort occurs more frequently and/or lasts for a longer period of time. Your carpal tunnel syndrome may flare up at night if you sleep with your wrists bent, or show up in the daytime when holding something for a prolonged period of time (using a phone, driving, etc.).

The main symptoms of carpal tunnel syndrome include:

Tingling and numbness

The most common symptom of carpal tunnel syndrome is tingling and numbness in your fingers and/or hand, often felt when you wake up in the morning. Usually, all fingers apart from your little finger are affected, and it can feel almost like an electric shock. If you leave your carpal tunnel syndrome untreated for an extended period of time, this feeling of numbness can become constant.

Weakness and pain

Due to the numbness in your hand and your thumb's pinching muscles, you may feel less strength and control in your hand. As a result, you might drop objects, find it harder to maintain a tight grip on objects, or struggle with fine movements like buttoning your shirt. This weakness can be accompanied by an aching pain in your hand that travels up your arm.

Generally, carpal tunnel syndrome is not caused by one single factor. It is likely that a number of risk factors have contributed to your condition developing. Some of these include:

Repetitive hand use

If you repeat the same hand or wrist motions or activities over a prolonged period of time, such as holding a computer mouse or working with vibrating tools, the tendons in your wrist become aggravated, causing your carpal tunnel to swell up and compress against your median nerve.

This happens especially when these activities involve your hands being lower than your wrists. Doing these movements in cold conditions can also increase the chances of them leading to carpal tunnel syndrome.

Underlying health conditions

Carpal tunnel syndrome is most typically caused by an underlying condition, especially conditions that affect your joints and bones. Rheumatoid arthritis, for example, causes inflammation in the joints and can affect the lining around the tendons in your wrist, leading to the carpal tunnel becoming narrower than usual and compressing against the median nerve. Some chronic illnesses, like diabetes, also increases the risk of nerve damage and you developing carpal tunnel syndrome as a result.

Other conditions that may lead to carpal tunnel syndrome include:

• Thyroid dysfunction (when your thyroid gland either produces too many or not enough hormones in your body)
• High blood pressure
• Menopause
• Kidney failure
• Lymphedema (swelling in the body's tissues)

Heredity and gender

Your carpal tunnel may be naturally smaller than others, which increases the chances of it squeezing against your median nerve. These traits can be passed down by your parents. It has also been shown that carpal tunnel syndrome is generally seen more frequently in women, due to the fact that the carpal tunnel is relatively smaller in women compared with men.

Trauma to your wrist

If you experience a traumatic injury to your wrist that causes a sprain, dislocation, or break (such as falling badly on your hand while playing sport), the swelling that follows can reduce the space within your carpal tunnel and lead to pressure on your median nerve.

Pregnancy

It could be that hormonal changes during pregnancy can lead to swelling that creates pressure on your median nerve. This is because you retain fluid when you are pregnant, which may consequently increase pressure within the carpal tunnel and irritate the median nerve. If you develop carpal tunnel when you are pregnant, it usually gets better on its own after you give birth.

Other potential causes of carpal tunnel syndrome

• Obesity
• Medications
• Hand or wrist deformity
• Alcoholism
• Tumour in the carpal tunnel
• Old age

Although there aren't any proven ways to ensure you don't develop carpal tunnel syndrome, there are some techniques to minimise the stress you put on your hands and wrists.

Change your grip

If your job requires gripping objects or extensive handwriting, take care to soften your grip if you can. You should also do what you can to avoid bending your wrist all the way up or down. If you type throughout the day, keep your keyboard at elbow height or a little bit lower.

Take breaks

You may have a job that involves doing the same hand and wrist motions all day. If this is the case, be sure to gently stretch and bend your hands and wrists every now and again. Doing this for a couple of minutes every hour can have a positive effect.

Keep your hands warm

If you spend prolonged periods of time in cold conditions, you're more likely to develop hand pain and stiffness, which can potentially lead to carpal tunnel syndrome. So, take care to wear gloves that keep your hands and wrists warm, or spend more time in warmer environments if possible.

Treat existing conditions

Conditions such as diabetes, rheumatoid arthritis, and high blood pressure can be a contributing factor to carpal tunnel syndrome. If you receive private treatment for these conditions with us at Circle, it may reduce the risk of you developing carpal tunnel syndrome.

At your initial consultation, your consultant will be able to see if you have carpal tunnel syndrome and what the next steps should be. If your consultant confirms that you do have this condition, and haven't responded to more conservative treatments (resting, wrist splints, nerve gliding exercises, etc.), they may recommend surgery. This consultation has three stages: medical history, physical examination, and tests.

Medical history

Your consultant will take time to understand your symptoms and how long they have been present for, as this can influence the kind of treatment you receive. There are some conditions with symptoms that are similar to carpal tunnel syndrome, so clarifying how exactly your discomfort feels and where you feel it is particularly important. For example, given that carpal tunnel syndrome doesn't affect the little finger, problems with that finger may be a sign of another problem.

Learning when your symptoms flare up is also important for your consultant to know. If they come at night, when you wake up in the morning, or when you are typing, it is more likely that you have carpal tunnel syndrome.

Physical examination

After taking down your medical history, your consultant shall walk you through a gentle examination of your hand and wrist. During this examination, they may:

• Press down and/or tap along the bottom of your palm to check for any tingling in your fingers (known as Tinel's sign)
• Bend and hold your wrists to check for any numbness or tingling
• Check for weakness and/or reduced function in the muscles at the base of your thumb
• Test how sensitive your fingertips and hands are by delicately touching them with a special instrument while your eyes are closed
• Check for muscle atrophy (when muscles degenerate and wear down) at the base of your thumb

Tests

To confirm that you have carpal tunnel syndrome and determine exactly how severe it is, your consultant may order a series of tests, such as:

Electrophysiological tests

These tests may include nerve conduction studies and an electromyogram (EMG). Nerve conduction studies work by measuring signals travelling in the nerves going through your hand and seeing where a nerve is not responding as quickly as normal. If your median nerve is not conducting its signal effectively, it tells your consultant that it has been compressed. An EMG measures the electrical activity of your muscle and shows whether you have any nerve damage. Together, these tests should be able to confirm if you have carpal tunnel syndrome.

Ultrasound

An ultrasound allows your consultant to get a clear picture of your bones and wrists. They will be able to tell if your median nerve has become compressed against your carpal tunnel by looking at the results.

MRI scans

Your consultant may also order an MRI scan, which provides clearer images of your soft tissues (ligaments, muscles, and tendons) than X-rays. It enables them to check for other causes of your symptoms and see if tissues are pressing against the median nerve, along with helping them see if there are any problems with the nerve itself.

To start with, your consultant will most likely recommend non-surgical treatments for your carpal tunnel syndrome. In cases where your symptoms worsen despite these techniques, they may recommend surgery.

Non-surgical treatment for carpal tunnel syndrome

If your carpal tunnel syndrome is diagnosed during its early stages, there are some non-surgical options that can ease your symptoms.

Wear a wrist splint

Your consultant may suggest that you wear a wrist splint when you sleep. This prevents you from bending your wrist during the night, keeping it in a neutral position instead and relieving pressure on the median nerve in your carpal tunnel, which should reduce your symptoms. You can also wear the splint during the day when doing activities that contribute to your carpal tunnel syndrome.

Carpal tunnel syndrome exercises

It could be that you are instructed to carry out some nerve gliding exercises, which are designed to help the median nerve move more freely throughout the carpal tunnel and avoid pressing against its confines. Combined with altering the activities you do that lead to your carpal tunnel syndrome, these exercises can help to prevent your condition from getting worse.

Medication and injections

To ease the swelling and pain caused by your carpal tunnel syndrome, your consultant may prescribe a series of anti-inflammatory medications, such as ibuprofen. They may also use a corticosteroid injection, which is a powerful anti-inflammatory medicine that can be injected into the carpal tunnel and calm your symptoms. If you only have carpal tunnel syndrome in a mild form, and haven't had the condition for long, these injections could relieve your symptoms on a long-term basis.

Surgical treatment for carpal tunnel syndrome

If your consultant decides that you require surgery for your carpal tunnel syndrome, there are two types of procedure that they might recommend: open carpal tunnel release surgery and endoscopic surgery.

Anaesthetic

Surgery for carpal tunnel syndrome is generally done under general anaesthetic, which means you'll be asleep for the entire operation and won't feel anything. If you prefer, however, the procedure can be performed with you under local anaesthetic. This means they numb your hand and wrist with a nerve blocking agent, which takes around six to 12 hours to wear off.

Open carpal tunnel release surgery

Your surgeon makes a small incision near the bottom of the palm of your hand so that they can view the inside of your hand and wrist. Using a special instrument, they will divide your transverse carpal ligament (the roof of your carpal tunnel), which widens the tunnel and relieves the pressure around your median nerve. The ligament may gradually grow together in a more lengthened fashion after surgery, but there will nonetheless be more space for your median nerve to pass through your carpal tunnel.

Once these steps have been completed, your surgeon will then close your skin with stitches and apply a bandage to your hand, ahead of you being woken up.

Endoscopic surgery

In endoscopy surgery, your surgeon will make two small incisions, known as portals, into the lower part of your palm. Once the first incision has been made, they will insert a small camera (an endoscope) to see inside your carpal tunnel, which allows them to see the area where your median nerve has become compressed. Other tiny instruments are then used in the second incision to cut the part of your transverse carpal ligament that was pressing against your medial nerve.

This form of surgery for carpal tunnel syndrome is seen as a less invasive treatment compared to open surgery, given how it means the skin and tissue above your carpal tunnel doesn't need to be damaged, meaning less pain and a potentially faster recovery time.

Generally, you will regain full strength in your wrist after six to 12 weeks. However, there is no set timeframe for when you may fully recover from carpal tunnel syndrome surgery. Everyone responds differently to surgery, and your recovery can be influenced by a variety of factors, such as.

• Your fitness levels
• Your everyday activities
• The nature of your job
• General health
• Your age

What happens immediately after carpal tunnel syndrome surgery?

If your surgery was performed under general anaesthetic, you will feel slightly weary when you wake up, but this is to be expected as you recover from the anaesthesia. You will be given a couple of hours to rest, ahead of your bandaged wrist being placed in a splint to keep it in a secure position and encourage the healing process. You may also be given a sling to support this process.

Carpal tunnel syndrome surgery is done on an outpatient basis, which means you'll be able to go home on the same day of your operation. Only in extremely rare cases will an overnight stay be necessary.

One to seven days after surgery

You may experience some discomfort after your operation, so we will supply you with pain relief medication for you to take at home and use whenever needed as you recover. For the first week, it is important that you keep your hand and wrist elevated, as this supports healing and reduces inflammation.

After two or three days, you'll be able to remove your bandage, but you must avoid getting the incision wet until your stitches have been taken out. You should be able to use your hand for light tasks, such as holding a glass or gently using a laptop keyboard. When you aren't using your hand, keep it elevated at all times, and don't let it dangle as you walk.

One to four weeks after surgery

During this period, you'll be able to gradually resume activities like brushing your teeth or handwriting. Your stitches will be taken out around 10 to 14 days after your surgery, as will the splint for your wrist.

If you have a job that doesn't demand any heavy lifting or other forms of intense exertion with your wrists (e.g., an office job), you should be able to return to work after two weeks, or possibly sooner. You will need to spend longer recovering before going back to a job that involves manual labour. When it comes to driving, you should be able to do this as soon as your wound has healed and you're able to safely grip your steering wheel. This typically takes around two weeks.

Once your stitches have been removed and you're out of your splint, you may be prescribed a series of strengthening exercises by your physiotherapist. Working the muscles in your hand and wrist should speed up recovery and help you get back to full strength.

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to suit your routine
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your specific needs
• Cosy and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about treatment for carpal tunnel syndrome, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in November 2022. Next review due November 2025.

1. Carpal tunnel syndrome, Ortho Info
2. Carpal tunnel release, John Hopkins