Carpal Tunnel

What is Carpal Tunnel Syndrome?

Carpal means wrist in Latin. The human carpal tunnel contains nine tendons and the median nerve. When the median nerve is under compression it manifests as a variety of sensory symptoms – typically numbness or “pins and needles” in the fingers, which we commonly label as “carpal tunnel syndrome” or CTS. Carpal tunnel syndrome is by far the most common entrapment neuropathy in humans. It is very common; but can be mimicked by a similar hand numbness, caused by nerve compression at the cervical discs in the neck.

Who gets Carpal Tunnel?

It occurs in men and women. It mostly occurs in patient aged over 50, but also in younger manual workers

Clinical Course

Once CTS is diagnosed, unfortunately it is sadly one of the few hand conditions whereby nerve decline is inevitable. Over the space of 3-4 years the compressed nerve will lose its electrical ability and irreversible damage can occur. Numbness can progress to even muscle loss in the late stages and then weakness at the thumb base. It is strongly advised in most cases to undergo nerve decompression surgery before this occurs and the sooner the better.

What Causes Carpal Tunnel?

90% cases show nil obvious cause, (DR Kirkham has a theory on this) however in 10% cases it can be

  • Wrist fractures – radius and or scaphoid
  • Rheumatoid arthritis
  • Cysts or ganglion
  • Gout
  • Hormonal imbalances / fluid retenetion / peripheral oedema – eg pregnancy, lactation, oestrogen imbalances, thyroid imbalances

Symptoms and Signs

Typically, patients will describe pins and needles, pain or numbness in the 3-4 fingers on the thumb side (radial side) of their hand – typically the little finger is uninvolved. It may cause you to lose sleep due to your numb and or you may start dropping things.

The physical examination by an experienced clinician should, provide the distinction and the diagnosis in most cases is made without the need for electrical tests.  nerve conduction studies can be done in a minority of cases, when in doubt, and will put the diagnosis beyond doubt.

Carpal Tunnel

Management

A brief keyhole (endoscopic) day surgical procedure is very often required.

Dr Kirkman has been doing endoscopic (keyhole) carpal tunnel release since he learned it in Houston Texas in 1999. Dr Kirkham uses the Microaire technique first described by Dr John Agee and can proudly say theta he has done the most cases in Australia. Dr Kirkham was therefore approached by the Microaire company to teach this technique to hand surgeons in Japan. Dr Kirkham is an instructor and runs courses to other surgeons on this technique. He has done original research on this topic and has presented it at state and national hand conferences for peer review. Dr Kirkham regularly speaks on this topic. The surgery is performed in a hospital under general anaesthetic and takes in my hands just 6 minutes for one hand or 15 minutes for 2 hands. It is day surgery.

Aftercare post endoscopic surgery

Patients may drive and shower within 1 day. Return to work is 2-10 for office jobs and 2-4 weeks for manual labourers

Results and sensory Improvements depend upon your disease severity, time delays before treatment, you’re your other comorbidities – but typically results are very pleasing. Dr Kirkham is planning more carpal tunnel research and publications.

If you think you have Carpal Tunnel Syndrome you should get a referral and then phone Dr Kirkham’s office on 02 9473 8585

Frequently Asked Questions

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Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry’s standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum.

Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry’s standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum.

Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry’s standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum.

Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry’s standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum.

Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry’s standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum.