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Carpal Tunnel Syndrome - Surgery

Carpal tunnel syndrome involves pain and numbness of much of the hand due to impingement of the median nerve in the carpal tunnel in the wrist. Most people with the condition can get by without surgery. Those who have surgery have these characteristics:

  • They have had no improvement after treating the condition without surgery. Usually a trial of perhaps three weeks to several months is necessary before considering surgery. If there is nerve damage, the decision to do surgery is stepped up.
  • The patient has severe symptoms that significantly alter the activities of daily living.
  • There is documented damage to the median nerve that is seen on nerve conduction studies.

When one has carpal tunnel release surgery, the pressure on the median nerve is released by cutting the ligament that is the top of the carpal tunnel. In some cases other things like benign tumors will need to be removed as well if they are discovered at the time of surgery.

There are a couple of choices regarding the type of surgery done to release the median nerve in the wrist. There is, for example, the open carpal tunnel release. The doctor makes a sizeable incision and dissects the tissues to the point of being able to see easily the transverse carpal ligament. It needs for the surgeon to make an incision in the hand and on the wrist before cutting the transverse carpal ligament. The recovery time is longer and the patient sustains a larger scar than is done in endoscopic surgery.

With the endoscopic carpal tunnel release surgery, only a small incision is created in the wrist. In some cases, two small incisions are made. The transverse carpal ligament gets cut endoscopically and the recovery time and pain after surgery is less. There is unfortunately a higher risk of having to repeat the surgery with the endoscopic technique.

There is an open technique being done that involves a smaller incision. This means that the recovery time and post-surgical pain is lessened. The surgeon still has the ability to have full view of the transverse carpal ligament.

Nerve conduction velocity testing and electromyograms are done before deciding on surgery options. These tests make surgery more successful. Pregnant women with carpal tunnel syndrome should wait until after they deliver to have surgery because the problem often goes away after the pregnancy is over. Conditions similar to carpal tunnel but that don't need surgery include rheumatoid arthritis and diabetes. There are many conditions that make carpal tunnel syndrome worse. Choose an endoscopic surgeon, if you wish, who has a great deal of experience with the endoscopic technique.

In general, carpal tunnel syndrome is performed without difficulty. Minor and major complications do occur, however, and patients must make sure they have a qualified surgeon do the job for them. Most complications are temporary and are simply managed by the patient or by the patient's surgery.

Minor complications include the following:

  • Infection.
  • Minor bleeding.
  • Swelling.
  • Numbness near the incision.
  • Stiffness of the wrist.
  • Painful scar.
  • Nausea or vomiting.
  • Reaction to tape, dressing or latex.

The major complications of the carpal tunnel release are very uncommon. Those who tend to have serious complications are those with heart problems, severe diabetes, kidney disease or lung disease. Some complications lead to a prolonged hospital stay. Some lead to the necessity of having another surgery and, in rare cases, permanent disability or death can occur.

The major complications of carpal tunnel surgery include the following:

  • Ulnar nerve damage.
  • Median nerve damage.
  • Numbness in parts of the hand.
  • Damage to an artery in the hand or wrist.
  • Serious infection.
  • Incomplete carpal tunnel release.
  • Finger stiffness.
  • Serious allergic reaction to medication.
  • Anesthetic reaction.
  • Death.
  • Carpal Tunnel Syndrome Overview

    Carpal tunnel syndrome is a condition in which repetitive motion and other causes make the median nerve "pinched" in the carpal tunnel of the wrist. This leads to feelings of numbness, muscle damage and weakness in the affected area. The area affected by the median nerve includes the thumb, the first, second and third digit and half of the fourth digit. The fifth digit is spared and is innervated by a different nerve.

    The parts of the hand noted above are innervated by the median nerve that travels down the forearm and passes through the carpal tunnel, a small area bound by tendons in the wrist. It is the narrowest spot the nerve goes through and, if the ligaments and tendons become inflamed during motions that cause the median nerve to become cramped, then carpal tunnel syndrome ensues.

    Repetitive motion injuries can come as a result of being a grocery store clerk, a computer keyboard operator, or any job requiring repetitive wrist motion. This can include sewing, assembly line jobs, driving, writing, painting, certain vibratory tools, racquetball, handball, playing certain musical instruments and other sports. Carpal tunnel is most common in those between the ages of thirty and sixty and women appear to have it more than men.

    Carpal tunnel syndrome is made worse by certain other medical conditions such as a previous fracture, having acromegaly, having alcoholism or diabetes, being hypothyroid, having kidney failure and being in menopause or having premenstrual symptoms. Pregnant women are more likely affected as are those with rheumatoid arthritis and related conditions. The obese are more likely affected.

    Symptoms of carpal tunnel syndrome includes tingling or numbness of the affected area of the hand, pain in the wrist extending up to the elbow in some cases, numbness of the palm of the hand, coordination difficulties involving the hand, a wasting away of the muscles of the thumb area, weakness of the affected hand and difficulty carrying even light objects.

    Doctors can test for carpal tunnel syndrome by finding numbness in the affected area of the hand with sparing of the fifth finger. If the doctor taps over the median nerve in the wrist, there can be shooting pain radiating out to the hand. This is called having a positive Tinel's sign. If the wrist is bent forward at a ninety degree angle to the arm for sixty seconds and there is repetition of the numbness and tingling of the hand, it is called a positive Phalen's test.

    An electromyogram can be done on the arm. Electrodes are inserted into the skin and the function of the nerve is measured. It will be diminished in the case of carpal tunnel along the median nerve. A nerve conduction velocity test will be abnormal. In some cases, x-rays are done to make sure there is no arthritis in the wrist as a cause of the pain and infirmity of the hand.

    The treatment of carpal tunnel may involve wearing a special splint that tips the wrist back slightly. The splint can be worn simply at night for several weeks in order to settle down the inflammation of the median nerve. Sometimes the splint is worn both day and night to keep the wrist from bending forward. Some doctors prescribe Lasix, a water pill, in order to shrink the swelling of the wrist and reduce the pressure on the median nerve. There are special types of keyboards and mouse devices for the computer so that the pressure is kept off the forearm. You can review the way you do your job and try and do it without repetitive motion of the wrist or wear a splint while working so as to prevent movement of the wrist. The same is true of any recreational activities you like to do that cause carpal tunnel syndrome.

    Some doctors will give you a steroid injection into the carpal tunnel to shrink swelling of the area and nonsteroidal anti-inflammatory medications are used to reduce inflammation and swelling. Surgery to release the median nerve is used as a last resort in cases where nonsurgical methods fail to resolve the carpal tunnel syndrome symptoms.

    Medical Negligence Solicitors

    Our personal injury solicitors operate a specialist medical negligence compensation service. Our Carpal Tunnel Syndrome solicitors deal with claims using a no win no fee arrangement which means that if you don�t win then you don�t pay them their professional costs. If you would like legal advice at no cost with no further obligation just complete the contact form or email our lawyers offices or use the helpline and a Carpal Tunnel Syndrome solicitor will review your medical negligence compensation claim and phone you immediately.

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    The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here