Carpal Tunnel Syndrome Treatment in Singapore

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm, becomes pressed or squeezed at the wrist within the carpal tunnel. This tunnel is a narrow passageway of ligaments and bones at the base of the hand. The condition can cause pain, numbness, and tingling in the hand and arm, affecting daily activities such as typing, gripping objects, or performing fine motor tasks. The symptoms typically develop gradually and may worsen without treatment.

Dr Chong Xue Ling
Senior Consultant Orthopaedic Surgeon

Symptoms of Carpal Tunnel Syndrome

The following symptoms may indicate the presence of carpal tunnel syndrome, ranging from mild to severe.

Numbness and tingling

These sensations primarily affect the thumb, index, middle and ring fingers, but not the little finger. Many patients report being woken at night by these sensations and needing to shake their hand to relieve symptoms.

Pain and aching

Discomfort may extend from the wrist up the arm to the shoulder or down into the palm and fingers. The pain may intensify during activities that involve wrist flexion or extension.

Weakness and clumsiness

The compression of the median nerve can lead to weakness in the hand, making it difficult to perform fine movements or maintain a grip on objects. Patients may drop things unexpectedly.

Muscle atrophy

In advanced cases, the muscles at the base of the thumb (thenar muscles) can waste away due to prolonged nerve compression, resulting in visible flattening of the thumb side of the palm.

Causes and Risk Factors

Several factors can contribute to the development of carpal tunnel syndrome, with some people being more susceptible than others:

Repetitive hand movements

Activities requiring prolonged or repetitive flexing of the wrist can increase pressure on the median nerve. These include activities like typing, using hand tools, or playing certain musical instruments.

Anatomical factors

Some people have a naturally smaller carpal tunnel or have experienced wrist injuries that changed the space within the tunnel. Fractures, dislocations and arthritis can alter the space available for the median nerve.

Health conditions

Certain conditions like diabetes, rheumatoid arthritis, and thyroid disorders can affect the nerves directly or cause swelling that puts pressure on the median nerve. These conditions may increase susceptibility to nerve compression.

Pregnancy and menopause

Hormonal changes during pregnancy and menopause can cause fluid retention, which may increase pressure within the carpal tunnel. The symptoms often resolve after delivery or hormone stabilisation.

Age and gender

Carpal tunnel syndrome is more common in older individuals and affects women more frequently than men. Women have relatively smaller carpal tunnels than men, which may contribute to this difference.

Diagnostic Methods

  • Physical examination: A doctor will assess hand strength, sensation, and appearance, looking for signs of muscle atrophy or weakness. The examination may include specific tests such as Tinel’s test (tapping over the median nerve) and Phalen’s test (holding the wrists in a flexed position) to reproduce symptoms.
  • Nerve conduction studies: This test measures how quickly electrical impulses move through the median nerve. Delayed conduction may indicate nerve compression within the carpal tunnel. The test can determine the severity of nerve damage and help guide treatment decisions.
  • Electromyography (EMG): EMG measures the electrical activity in muscles when they contract and when they’re at rest. This test can help determine if muscle damage has occurred and if other conditions might be causing the symptoms.

Treatment Options

Treatment for carpal tunnel syndrome aims to relieve pressure on the median nerve and manage symptoms effectively.

Wrist splinting: Wearing a splint keeps the wrist in a neutral position, reducing pressure on the median nerve. Splints are often recommended for night use but can be worn during activities that aggravate symptoms.

Activity modification: Changing how certain tasks are performed or taking more frequent breaks during repetitive activities can help reduce symptoms. Ergonomic adjustments to workstations or tools may also provide relief.

Medications: Nonsteroidal anti-inflammatory drugs can temporarily relieve pain. Corticosteroid injections into the carpal tunnel may reduce inflammation and swelling, providing temporary relief for some patients.

Physical therapy: Specific exercises can help improve wrist strength and flexibility. Therapists may also teach nerve gliding exercises designed to help the median nerve move more freely within the carpal tunnel.

Carpal tunnel release: This procedure involves cutting the ligament that forms the roof of the carpal tunnel to increase the space and reduce pressure on the median nerve. The ligament gradually reforms while allowing more room for the nerve.

Endoscopic surgery: This technique uses a thin tube with a camera attached (endoscope) to guide the surgeon in cutting the carpal ligament through one or two small incisions. This approach may allow faster recovery than open surgery.

Open surgery: The surgeon makes an incision in the palm over the carpal tunnel and cuts through the ligament to free the nerve. This traditional approach allows direct visualisation of the surgical area but may require longer recovery time.

Prevention and Management

Prevention focuses on minimising stress on the hands and wrists. Maintaining good posture while working helps reduce strain on the upper extremities. Using ergonomic equipment, such as split keyboards or padded mouse pads, can keep wrists in a natural position. Taking regular breaks from repetitive activities allows tissues to recover. Stretching exercises for the hands and wrists before activity can improve flexibility. For existing carpal tunnel syndrome, management involves following the treatment plan, performing recommended exercises, and making lifestyle modifications to prevent symptom recurrence.

Are Your Symptoms Affecting
Your Quality Of Life?

Consult our Dual Fellowship-Trained Orthopaedic Surgeon for an accurate diagnosis & personalised treatment plan today.

Dr Chong Xue Ling

Dr Chong Xue Ling

Senior Consultant Orthopaedic Surgeon

Dr Chong Xue Ling is a Swiss fellowship-trained orthopaedic surgeon specialising in foot and ankle, as well as shoulder and elbow surgery.

She is a member of the European Group for the Study and Research of Minimally Invasive Surgery of the Foot and Ankle. For shoulder and elbow surgery, she completed her fellowship at La Tour Hospital, an accredited Swiss Olympic Medical Centre and learnt innovative techniques in arthroplasty for earlier return to activity as well as the stabilising techniques, developed to have greater strength without extensive fixation.

  • MBBS (S’pore)
  • MRCS (Ireland)
  • MMed Orthopaedic (S’pore)
  • FRCS Orthopaedic (Edinburgh)

Through active involvement in research, she aims to constantly improve existing treatment in the pursuit of quality care for her patients.

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    Carpal Tunnel Syndrome

    Frequently Asked
    Questions

    Can carpal tunnel syndrome affect both hands?

    Yes, carpal tunnel syndrome can occur in both hands, though one hand may be affected more severely than the other. Bilateral symptoms may indicate a systemic condition contributing to the nerve compression.

    How long does recovery from carpal tunnel surgery take?

    Recovery time varies by individual and surgical technique. Grip and pinch strength usually return within 2-3 months, though complete recovery may take up to a year in some cases.

    Will carpal tunnel syndrome go away on its own?

    Mild cases, especially those related to pregnancy or temporary activities, may resolve without treatment. However, most cases require intervention to prevent progression and permanent nerve damage.