Orthopaedic surgeon specialising

Carpal Tunnel Syndrome

Dr Steven Frederiksen specialises in the treatment of Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome (CTS) is an entrapment idiopathic median neuropathy, causing paresthesia (tingling), pain and numbness in the hand. Symptoms may initially occur at night and progress to daytime activity. More severe conditions will involve constant numbness and tingling. The median nerve is compressed as it travels through a tunnel which consists of the small bones of the wrist and also a ligament (transverse carpal ligament).

 

Diagnosis

 

Diagnosis of this condition is largely clinical. The history of the symptoms stated above is then confirmed with clincal examination. Most patients will also undergo nerve conduction studies to confirm the presence of changes within the median nerve. It should be noted that 8 - 20% of patients with carpal tunnel syndrome will have normal nerve conduction studies.

 

Management

 

Once the diagnosis of carpal tunnel syndrome has been made, your management will depend on a number of factors including the severity of your condition. Initial nonoperative management will include activity modification and the use of splints provided by hand therapists. Dr Frederiksen does not routinely use injections of local anaesthetic and corticosteroid.

 

If your symptoms persist despite nonoperative management, or they are severe on initial assessment, you will be advised to have an operation. Dr Frederiksen performs carpal tunnel decompression in two ways. Both methods have very similar long term outcomes but Dr Frederiksen has noted some slight differences early in the postoperative phase.

 

The first method to release the carpal tunnel is by standard open technique. This involves making a three centimetre (approximate) incision from the wrist crease towards the fingers, in line with the thumb side of the ring finger. Dissection is undertaken down to the structure that compresses the nerve and it is then released, taking care to completely decompress it. Once that has been done, any bleeding noted is stopped and the skin is sutured with a dissolving suture.

 

Dr Frederiksen's preferred method when able is to perform the endoscopic technique. This involves making a one centimetre incision in one of the creases near the wrist, as well as another smaller incision in the palm. Special instruments are used then to visualise and divide the compressing structures from within. If there is any problem with visualising structures or concern that structures are at risk, Dr Frederiksen will convert the procedure for safety reasons to the open technique. He has found this to occur in less than one percent of his cases. Once the ligament has been released, dissolving sutures and steri strips are then used to close the wounds.

 

After the operation you will be placed in dressings and a bandage. You should leave these intact for three to five days before removing them. The wound dressings remaining should then be left until removed by Dr Frederiksen or a therapist.

 

The risks involved in these procedures will be outlined further at the time of consent, but can be broadly categorised into general and specific risks. General risks are those of any operation and include bleeding, infection, pain reaction called CRPS, scarring, tourniquet risks and anaesthetic risks. Specific risks for carpal tunnel release include limited improvement in all or some of the symptoms, damaging specific structures such as branches of the median nerve, an ache at the base of the hand that can continue for several weeks after the operation and the need for another procedure.

 

After the operation you should arrange to have some time off work and a subsequent period of light duties, both at work and in the home.  Moderate to heavy activities should be avoided for four to six weeks before a gradual reintroduction of activity. Your hand will let you know if you're overdoing it in that month or two after the operation. 


If you are experiencing any CTS related symptoms, you can request a referral to Dr Steven Frederiksen from your GP.