Carpal Tunnel Syndrome (CTS) is one of the commonest hand conditions we see and treat. CTS results from increased pressure on one of the major nerves, the median nerve in the wrist. Women over the age of 50 are particularly susceptible. It is also common in the diabetic patient.

The patient presents with increasing pain and discomfort in the hand. The thumb and first two fingers go "dead" with numbness and pins & needles. Typically have night pain, awake and have to "shake the hand out" to relieve the pressure. There is a loss of dexterity to hand, a burning sensation and loss of power particularly to the thumb.

Treatment is aimed at relieving pressure on the nerve. Conservative treatment:

• Night splints for the wrist (anti-inflammatories and durectics have very little effect and I do not use these).
• Cortisone injection into the carpal tunnel, very useful and effective on decreasing the inflammation and allowing the nerve to recover, this may however be temporary.

If symptoms persist, surgical treatment is advocated. Open carpal tunnel release can be done under local or general anaesthetic with a 5cm incision over palm of hand. The Transverse carpal ligament released, creating more space for the median nerve.

Endoscopic carpal tunnel release (minimally invasive keyhole surgery) with 1cm incision at wrist crease. Both carpal tunnels can be done at the same time. Grip strength and return to work is twice as quick as open surgery. I have been doing this for the past 9 years and have performed 300 cases.

Carpal tunnel syndrome surgery is a day case procedure. Following surgery you are placed in a bulky dressing which is changed at 3 days to a light small dressing. Sutures are removed at 12 to 14 days. We encourage immediate active movement. You can type on a computer the day after surgery, drive your car by day two. We want you to continue with all your normal activities of daily living.

Endoscopic Carpal Tunnel Release (2016)