Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is the most common peripheral nerve compression disorder in the upper limb, affecting approximately one in ten people during their lifetime.
The carpal tunnel is a narrow passage in the wrist — formed by the carpal bones on three sides and a tough ligament called the flexor retinaculum on the fourth. Through this tunnel runs the median nerve along with nine flexor tendons.
When pressure within the tunnel rises — from swelling, anatomical changes, or surrounding tissue thickening — the median nerve becomes compressed. This disrupts the nerve's ability to conduct electrical signals, producing the hallmark symptoms of CTS. Left untreated, prolonged compression can result in permanent nerve damage and muscle wasting.
Carpal Tunnel Syndrome Symptoms
Symptoms typically affect the thumb, index, middle, and the thumb-side of the ring finger — the territory supplied by the median nerve. Common presentations include:
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Numbness and tingling in the hand, often waking patients at night
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Burning or aching pain in the wrist and palm, sometimes radiating to the forearm
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Weakness when gripping or pinching — patients frequently drop objects
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Altered sensation making fine tasks (buttoning, typing) difficult
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Thenar wasting — visible flattening at the base of the thumb in advanced cases
A key diagnostic clue is nocturnal symptoms: waking in the night to "shake out" the hand is strongly associated with CTS and should prompt an early specialist review.
Causes & Risk Factors
In the majority of cases, no single cause is identified — this is termed idiopathic CTS. However, a number of conditions and lifestyle factors increase the risk:
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Pregnancy and fluid retention
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Diabetes mellitus and thyroid disorders
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Rheumatoid arthritis and inflammatory conditions
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Previous wrist fracture (e.g. distal radius fracture)
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Repetitive manual work and prolonged wrist flexion
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Obesity
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Genetic predisposition and female sex (women are three times more commonly affected)
Non-Surgical Treatments
For mild to moderate CTS, non-operative management is the appropriate first step. Mr Edwards takes a staged, evidence-based approach tailored to each patient's symptom severity, occupation, and lifestyle.
Wrist Splinting
A neutral-position wrist splint worn at night keeps the wrist from flexing and relieves pressure on the median nerve during sleep — the period when symptoms are often worst. Splints are safe, inexpensive, and effective for early or pregnancy-related CTS.
Corticosteroid Injection
An ultrasound-guided steroid injection into the carpal tunnel reduces local inflammation and swelling, providing meaningful relief in 70–80% of patients. Effects typically last several months and the injection can be repeated. It is particularly useful as a diagnostic test and as a bridge to surgery.
Activity Modification & Physiotherapy
Identifying and reducing provocative activities — sustained gripping, vibrating tools, or prolonged keyboard use — can ease symptoms. Nerve-gliding exercises may complement other treatments in selected patients.
Surgery
Surgery is recommended when symptoms are severe, when nerve conduction studies confirm significant median nerve compression, or when conservative treatment has failed. Carpal tunnel decompression (carpal tunnel release) is one of the most frequently performed procedures in hand surgery, with excellent outcomes and a low complication rate.
Open Carpal Tunnel Release
A small incision (2–3 cm) in the palm allows direct division of the flexor retinaculum under local anaesthetic. This is the gold-standard technique: safe, reliable, and suitable for all severity levels. The procedure takes approximately 15 minutes and is performed as a day case.
What to Expect at Mr Edwards' Clinic
At your initial consultation, Mr Edwards will take a detailed history, perform a focused clinical examination, and — where indicated — arrange nerve conduction studies (NCS/EMG) to confirm the diagnosis and grade its severity. You will receive a clear, jargon-free explanation of your diagnosis and a personalised treatment plan with time to discuss all options.
If surgery is recommended, a pre-operative assessment appointment will be arranged. Most procedures are performed under local anaesthetic as a day-case procedure at a fully accredited hospital facility, so there is no overnight stay. The entire surgical episode — from arrival to discharge — typically takes under two hours.
Recovery Times
Recovery varies by individual and occupation, but patients can generally expect the following timeline:
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Day 1–3: Wound dressing in place; the hand can be elevated and fingers moved gently
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1–2 weeks: Suture removal; light activities with the hand are encouraged
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2–4 weeks: Return to light office work or desk-based employment
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4–8 weeks: Return to manual or physical work; driving usually from 2 weeks
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3–6 months: Full resolution of scar sensitivity; nerve symptoms continue to improve
Numbness and tingling often improve within days of surgery. Complete nerve recovery — particularly in longer-standing or severe cases — may take several months as the median nerve regenerates.