Hand Surgery

Carpal Tunnel

Hand Overuse Syndromes including Carpal Tunnel Syndrome

Normally the hand copes well with the stresses of everyday living and heavy use due to its remarkable healing abilities. However there is a limit for injury above which enduring tissue damage occurs. This process is termed an ‘overuse syndrome’, and is most frequent in the arm. Most overuse syndromes involve muscle-tendon and ligament structures or the peripheral nerves close to joints. Commonly symptoms appear some time after the stress commenced and may resolve with rest, only to reoccur after resumption of stressful activity. With time, changes can occur that result in persistent symptoms – even at rest. Intermittent symptoms of pain, swelling, muscle weakness or numbness may become continual with time. There are a number of named syndromes that result from overuse, including nerve conditions as well as muscle-tendon and ligament syndromes:

Nerve syndromes:

Carpal Tunnel Syndrome CTS (compression of the median nerve)
Pronator Syndrome (compression of the median nerve)
Radial Nerve Entrapment (superficial radial nerve compression or posterior interosseous nerve PIN  compression)
  • Cubital Tunnel Syndrome (compression of the ulnar nerve)

Muscle – Tendon and Ligament syndromes:

  • Trigger Finger (stenosing tenovaginitis of the flexor tendons)
  • DeQuervain’s Disease (stenosing tenovaginitis of thumb extensor tendons)
  • Tennis Elbow (lateral epicondylitis)
Ganglion tumours of the hand, wrist and fingers

If you have been diagnosed with an overuse condition contact, please contact our expert hand and plastic surgeon, Dr. Richard Hamilton in Adelaide, to discuss and plan the most effective treatment.


Surgical Treatment

The principle of treatment is based on identifying the injured structure(s) and removing the stress factors that produced the injury, while the tissues recover. Hand surgery is often used as the treatment of choice in the management of overuse conditions in two situations. If there is an anatomical defect such as a tight fibrous ligament compressing a nerve or tendon, it can be decompressed surgically (as in a carpal tunnel release), or if inflamed tissue is affecting hand function it can be removed as in a synovectomy. When symptoms have been resolved by hand surgery, early self mobilisation or hand therapy may used to strengthen the injured tissues to assist return to normal manual activities. Correct diagnosis and surgical management is essential for a satisfactory outcome in the treatment of hand overuse syndromes. It is important that your assessment is undertaken by an experienced and qualified hand surgery specialist.

Dr. Hamilton will be happy to answer any questions you have about hand surgery and the treatment of strain injuries. If you feel you have a hand overuse syndrome, please contact our Adelaide practice to schedule a consultation or ask your GP for a referral.

Carpal Tunnel Syndrome CTS (Median Nerve)

Carpal Tunnel Syndrome refers to pressure on the median nerve as it runs through the carpal tunnel, a narrow channel of bones and ligament at the at the wrist and base of the hand, causing tingling numbness and pain in the fingers, hand and wrist, weakness, and eventually permanent muscle and nerve damage.

The carpal tunnel is an area near the front of the wrist that encloses the median nerve, one of the major nerves of the hand as well as nine adjacent flexor tendons. The tunnel is a rigid structure composed of bones and a ligament called the flexor retinaculum, which acts as a pulley for the underlying tendons to the fingers. When pressure builds up within the tunnel because the tendons surrounding the median nerve are swollen, there is pressure on the nerve as the tunnel cannot expand. This produces symptoms of numbness or tingling sensations as well as pain in the areas of the hand controlled by the median nerve, namely the first three fingers and thumb – a condition known as carpal tunnel syndrome. Symptoms are often worse at night. Carpal tunnel syndrome, which is a nerve compression condition, requires a thorough hand assessment by a plastic and hand surgery specialist to verify the diagnosis. Nerve conduction studies may assist in the diagnosis.

Carpal tunnel syndrome can be caused by any number of factors, including repetitive wrist and hand movement (generally work-related), injury to the hand, awkward sleeping positions, arthritis, obesity, diabetes, old age and more. Patients who are experiencing abnormal feeling in their fingers, particularly at night, may be suffering from the early stages of carpal tunnel syndrome. People with office jobs that require significant repetitive use of a computer keyboard are at risk of developing carpal tunnel syndrome.

Carpal Tunnel Hand Surgery – Who are the Candidates?

Carpal tunnel syndrome can vary in intensity. When conservative measures, such as splinting, prove to be ineffective, then surgical decompression of the median nerve, ‘carpal tunnel release’, is the most effective treatment option.

During a hand surgery consultation with Dr. Hamilton at our Adelaide or peripheral offices, patients will have their hand examined for strength, function and sensitivity to ensure a correct diagnosis. Sometimes testing is also arranged in the form of a nerve conduction study, which will usually indicate the presence of a nerve conduction block, significant in carpal tunnel syndrome. After a thorough diagnostic session, Dr. Hamilton may recommend a procedure known as carpal tunnel release.


Carpal Tunnel Release – Surgery Procedure

Carpal tunnel release is a surgical procedure on the hand, which decompresses the median nerve at the level of the carpal tunnel. Dr. Richard Hamilton undertakes carpal tunnel release either under local or intravenous sedation anaesthesia at his Hamilton House Day Surgery facility in Adelaide.

Dr. Hamilton’s favoured procedure is the ‘short scar incision carpal tunnel release’, where the carpal ligament is divided under full vision through a 2.5cm incision in the palm under local anaesthetic or sedation, which allows a rapid recovery and low complication rate. In heavy manual workers, the median nerve can be decompressed and carpal ligament reconstituted, facilitating preservation of grip strength.

Carpal tunnel hand surgery is performed as a day surgery procedure allowing patients to return home the same day. There may be some mild discomfort following surgery relieved by painkillers, but recovery is quick and normal daily living activities can be resumed almost immediately. In most cases a dressing is left over the incision line for 5 days to ensure full healing and maximal functional outcome. As the transverse carpal ligament is divided it will be about 6 weeks before the grip strength returns to normal. And for most patients, there will be an immediate improvement in their nerve compression symptoms, with rapid relief of pain and numbness.

If you have been diagnosed with carpal tunnel syndrome and are a candidate for surgical release, contact Dr. Hamilton at his Adelaide practice to schedule a consultation.