Nerve compression

The commonest form of nerve compression in the hand is the carpal tunnel syndrome. The nerve that supplies most of the feeling to the hand passes into the hand through a constricted space at the wrist known as the carpal tunnel. Here it is accompanied by nine tendons and their lubricating membranes. Swelling within the carpal tunnel compresses the nerve restricting its blood supply causing a mixture of symptoms of pain, tingling, numbness and weakness.

A careful diagnosis is required which may involve electrical studies recording the speed and intensity of nerve conduction. In the early stages a carpal tunnel syndrome can be treated with a variety of measures including steroid injections which reduce swelling and therefore pressure.

If carpal tunnel syndrome is well established, particularly where there is weakness and persistent numbness, surgical decompression is usually advised. This involves a small incision over the front of the wrist to release the tight ligament that is enclosing the carpal tunnel. Once pressure has been released from the nerve it takes a variable amount of time for nerve function to recover which depends on the severity of compression.

A firm dressing is kept in place for two weeks following surgery at which time dressings and sutures are removed. It usually takes six weeks to regain normal hand function.

Other forms of nerve compression of the median nerve in the forearm and the ulna nerve at the elbow or wrist can also be released surgically.