Carpel Tunnel syndrome.
What is carpel tunnel syndrome?
Carpel tunnel syndrome ( also known as median nerve neuropathy) is a very common progressive painful hand and arm condition caused by a pinched nerve in your wrist. This causes the classic tingling in the thumb, fore finger and middle finger and/or the ring fingers.
Bound by bones and ligaments, the carpal tunnel is a narrow passageway, about as big around as your thumb, located on the palm side of your wrist. The “Tunnel” is formed by the metacarpal bones of the wrist; the small bones form a small archway which the tendons and nerves pass through. This median nerve to your hand and the nine tendons that bend your fingers are protected by this bony arch.
For reasons which are not fully understood this tunnel becomes constricted and tight over a period of time. The transcarpel ligament can become stiff and push down and pinch the median nerve. There are many factors thought to increase your risk of developing this problem including, arthritis, congenital, and some repetitive movements.
Symptoms:
The progressive compression of the nerve produces the numbness, pain in the fingers and eventually wastage of the muscle at the base of the thumb that characterize carpal tunnel syndrome.
You may tend to drop things more often due to the weakened grip mechanism.
Patients very often complain of tingling and numbness or pain in the night. This pain can be enough to wake you up at night. Symptoms may appear whilst holding the steering wheel or cycling due to the position.
Carpel tunnel may appear and cause problems during pregnancy, then resolve shortly after the baby is born.
Carpel tunnel syndrome is a little known cause of , as the hand pain deflects upwards from the hand to the shoulder. This “shoulder problem” may cause the person to seek medical advice.
Diagnosis:
At the clinic your specialist will take your history and examine your hand looking for signs of Carpel tunnel syndrome such as the wasting of the muscle at the base of the thumb.
The doctor may test the strength in both hands comparing both hands. He may place pressure on the median nerve to provoke the symptoms and confirm the diagnosis. He may send you for a very simple test to confirm the diagnosis. 
During the test, called an , small electrical impulses are sent down the nerves to the hand. The results will confirm that the median nerve is compressed and its function is altered.
If your specialist confirms that you have carpel tunnel syndrome he may prescribe for you physiotherapy or send you to be fitted for hand splints to wear at night. This may relieve the symptoms for a period of time. You may be advised of activities or positions to avoid. Dr may prescribe painkillers to help relieve your pain.
The definitive treatment is a performed under local anaesthetic. During the operation the surgeon makes more space and frees the trapped nerves. This operation is done as a day case.
During the surgery the Dr makes a small incision on the base of the palm side of your hand. He divides the transverse carpel ligament and at the same time frees the trapped median nerve. After making sure the nerve moves freely the wound is closed with stitches.
You will leave the hospital with a heavy bandage and a sling. After the first two days you may remove the heavy bandage leaving behind a small wound dressing. The stitches are removed in clinic after two weeks after which time you may gradually resume your normal activities.
If left untreated Carpel tunnel syndrome causes muscle wastage at the base of the thumb leading to loss of strength in the pincher movement between the thumb and first finger. The loss of strength in the finger thumb grip can be disabling and restrict some fine motor skill activities.
