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CARPAL TUNNEL SYNDROME


Sometimes patients may notice numbness which can become progressively worse. The numbness usually occurs in the thumb, index and middle fingers. It is worse in the morning or during daily activities, like talking on the phone for long periods of time, while using the computer for too long, reading newspaper or when even doing a lot of housework. Holding small objects such as buttons becomes very difficult.
If you experience such numbness or pain when you put the flexed elbow on the table with the wrist bent, it is advisable to see an orthopaedic surgeon.
What is carpal tunnel syndrome?
It is caused by the pressure of a ligament (the transverse carpal ligament) on a nerve, the Median Nerve which supplies “feeling” to the thumb, index and middle fingers. Patients are referred to a neurologist for a nerve conduction test. This consists of a painless mild electrical stimulation to the tip of the middle finger to see if there is an obstruction to the normal nerve transmission of the Median Nerve at the wrist. This causes the numbness and sometimes weakness especially when using the thumb and index finger to pinch. Sometimes patients can try wearing a wrist splint to reduce movement at the wrists and medication to improve the nerve function. Unfortunately, this does not always relieve numbness. A minor operation to relieve the pressure of the ligament on the Median Nerve is an option. It is done by making a cut through the ligament that is pressing on the nerve so that blood can flow without obstruction through the nerve. This can be done in 3 ways:

    • An open operation consists of an incision of about 2.5 cm over the palm near the wrist

The new methods make use of keyhole surgery:

    • Knifelite surgery: a form of keyhole surgery using a special instrument, a Knifelite, introduced through a small incision of about 1 cm on the palm.
    • Endoscopic Surgery: a form of keyhole surgery using an endoscope which consists of making two 1-cm incisions on the palm and wrist.

The first two procedures can be done under local anaesthesia in the doctor’s office or in the hospital as a day surgery. The third procedure has to be done in the hospital as a day surgery as an endoscope is required. Stitches are usually removed 2 weeks later, leaving a slightly tender scar for a month. Numbness disappears after 3 months.

1. Area of pain and numbness in CARPAL TUNNEL SYNDROME
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2. Wrist brace to reduce movements
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3 KNIFE-LITE
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4. Open method for CARPAL TUNNEL release: shows constriction of the median nerve
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5. Incision for an open CARPAL TUNNEL release
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6. Incision for KNIFE-LITE CARPAL TUNNEL release
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7. Incisions for endoscopic CARPAL TUNNEL release
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