Carpal Tunnel Syndrome (CTS) is the most common nerve entrapment in the arm. It is caused by a compression of the median nerve in the carpal tunnel at the wrist. Sometimes treatment might involve surgery to release pressure on the median nerve. Following this, however, the fingers may still tingle, feel numb or be painful, and there is a simple reason for this.
Symptoms include numbness and tingling in the palm, thumb, index and middle fingers, especially overnight. The symptoms may also extend into forearm or elbow. Other symptoms may include weakness or clumsiness of the hand.
Carpal Tunnel Syndrome can usually be diagnosed by thorough assessment by your therapist, but nerve conduction and EMG studies can also help with a diagnosis. Treatment for Carpal Tunnel Syndrome can be conservative (eg night splinting, exercises and activity modification) or surgical. Longstanding Carpal Tunnel Syndrome or Carpal Tunnel Syndrome that has proximal radiation of symptoms is less likely to respond to conservative treatment.
In the treatment of Carpal Tunnel Syndrome, recovery periods are extremely variable. This is because damaged nerves have slow and variable rates of regeneration. While the recovering nerve regenerates, you may still feel symptoms in your fingers, even after surgery. Most patients notice an improvement in their symptoms within the first few days, but some patients have ongoing symptoms for up to 3 months following surgery.
Even following a surgical release, in some cases a complete recovery may not be possible. There are a few reasons that symptoms can still be present following surgery.
- If the nerve is still mechanically compressed, then symptoms will continue into the fingers. For example, Carpal Tunnel Syndrome that is caused by repetitive gripping may be due to well-developed deep hand muscles gliding into the carpal tunnel area with full grip activity. This increases the content and thus pressure in the carpal tunnel. Symptoms will remain until treatment focussing on grip and activity modification is commenced.
- If the nerve has been compressed for a long time there may have been damage to the nerve and a full recover in this instance is not always possible despite the decompression surgery
- If the nerve has been compressed and is quite flat, it can take time to recover after a decompression – sometimes it does not just ‘spring’ back to life as it once was. It takes time.
- If the nerve is also compressed at the elbow, shoulder or neck, then symptoms will remain until the alternate sites of compression are also treated.
Article Reference: Written by Ashley Pattison, Physiotherapist, Riverina Hand Therapy.