Coastal Plastic Surgery & Medi Spa — Erina NSW Carpal Tunnel Syndrome
Carpal tunnel syndrome is one of the most common conditions affecting the hand and wrist. At Coastal Plastic Surgery, our specialist plastic surgeons offer both non-surgical and surgical treatment options, with carpal tunnel release providing long-lasting relief for most patients.
What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) develops when the median nerve — which passes through a narrow channel at the base of the wrist called the carpal tunnel — becomes compressed. The carpal tunnel is bounded by the carpal bones at its base and the transverse carpal ligament across its top, and also contains the nine tendons that flex the fingers and thumb.
When the space within the tunnel narrows or its contents swell, pressure builds on the median nerve. This causes the characteristic symptoms of pain, numbness, tingling, and weakness in the thumb, index, and middle fingers — the area of the hand supplied by the median nerve.
Carpal tunnel syndrome is the most common peripheral nerve compression disorder. It is more common in women, in older adults, and in people whose work involves repetitive hand and wrist movements.
The median nerve supplies sensation to the thumb, index finger, middle finger, and the radial (thumb) half of the ring finger — typically described as the area covered by a fingerless glove. It also supplies the small muscles at the base of the thumb (thenar muscles) that are responsible for pinch grip.
In advanced carpal tunnel syndrome, weakness and wasting of these thenar muscles can develop, causing permanent reduction in grip strength if not treated.
If you are experiencing numbness, tingling, or pain in the hand — particularly at night or with sustained activities such as driving or holding a phone — you should seek assessment. Untreated carpal tunnel syndrome can result in permanent nerve damage and muscle wasting. Early treatment gives the best outcomes.
Recognising carpal tunnel syndrome
The symptoms of carpal tunnel syndrome are caused by compression of the median nerve at the wrist. They typically affect the thumb, index, middle, and part of the ring finger. If untreated, symptoms can spread up the forearm and beyond the elbow.
Symptoms that wake you from sleep — typically numbness or tingling in the fingers — are a classic feature of carpal tunnel syndrome. Shaking the hand to relieve the tingling (the "flick sign") is characteristic. Night symptoms occur because the wrist tends to flex during sleep, further narrowing the carpal tunnel and increasing pressure on the median nerve.
What causes carpal tunnel syndrome?
Carpal tunnel syndrome results from any factor that increases pressure within the carpal tunnel or reduces the space available for the median nerve. In many cases, no single cause is identified — rather a combination of factors is responsible.
How is carpal tunnel syndrome diagnosed and graded?
Carpal tunnel syndrome is diagnosed on the basis of symptoms, clinical examination findings, and nerve conduction studies. Grading the severity helps guide treatment decisions.
Clinical tests including the Phalen manoeuvre (sustained wrist flexion reproducing symptoms), Tinel sign (tapping over the carpal tunnel), and the hand elevation test may support the diagnosis. Thenar muscle wasting indicates advanced disease.
Nerve conduction studies (NCS) and electromyography (EMG) are the gold standard investigations. They measure the speed of electrical conduction in the median nerve and can confirm the diagnosis, assess severity, and exclude other causes of hand symptoms.
| Severity | Features | Typical treatment |
|---|---|---|
| Mild | Intermittent symptoms, normal NCS or mild slowing | Splinting, activity modification |
| Moderate | Persistent symptoms, moderate NCS slowing | Splinting, steroid injection, or surgery |
| Severe | Constant symptoms, significant NCS slowing, thenar wasting | Surgery recommended promptly |
Nerve conduction studies (NCS) measure the speed at which electrical signals travel along the median nerve. In carpal tunnel syndrome, the nerve conducts more slowly across the wrist due to compression. NCS help confirm the diagnosis, assess severity, and guide treatment planning. Your GP can arrange a referral for nerve conduction studies, or our surgical team can arrange these following your consultation.
Numbness and tingling in the hand can arise from causes other than carpal tunnel syndrome, including cervical radiculopathy (neck nerve compression), thoracic outlet syndrome, cubital tunnel syndrome (ulnar nerve at the elbow), diabetic neuropathy, and peripheral vascular disease. Your surgeon will assess to ensure the correct diagnosis before recommending treatment.
Surgical & non-surgical treatment
Treatment for carpal tunnel syndrome depends on the severity of symptoms and the degree of nerve compression. Non-surgical treatments are appropriate for mild to moderate CTS. Surgery is recommended when conservative measures have failed, when symptoms are severe, or when there is evidence of progressive nerve damage.
Wrist Splinting
A neutral wrist splint worn at night — and sometimes during the day — keeps the wrist in a position that minimises pressure on the median nerve. Most effective for mild to moderate CTS, particularly night symptoms. Results may be temporary.
Activity Modification
Avoiding sustained wrist flexion and repetitive gripping activities can reduce symptoms. Ergonomic adjustments to workstation and tool grip can help manage mild CTS, particularly when occupational factors are contributing.
Corticosteroid Injection
A steroid injection into the carpal tunnel can reduce inflammation and provide significant symptom relief. This is a temporary measure — most patients experience relief for months, though symptoms typically recur. Useful for diagnosis confirmation and as a temporising measure in pregnancy.
Treatment of Underlying Conditions
Where CTS is associated with an underlying medical condition — such as hypothyroidism, diabetes, or rheumatoid arthritis — optimising treatment of the underlying condition may improve symptoms.
Open Carpal Tunnel Release
The standard surgical treatment. Under local anaesthetic, a small incision is made in the palm and the transverse carpal ligament is divided, permanently releasing pressure on the median nerve. This is a short day procedure with a very high success rate.
Endoscopic Carpal Tunnel Release
A minimally invasive technique where the carpal ligament is divided using a small camera and blade through a smaller incision. Equivalent long-term outcomes to open release, with potentially faster return to activities for some patients. Your surgeon will advise which approach is most appropriate for your situation.
Carpal tunnel release is performed under local anaesthetic as a day procedure. The operation takes approximately 15–20 minutes. A dressing is applied and the hand is kept elevated for the first few days to reduce swelling. Most patients can use their hand for light activities within a week. Return to heavier activities typically takes 2–6 weeks depending on the nature of your work. Grip strength gradually recovers over several months.
Symptoms of numbness and tingling often improve rapidly after surgery — sometimes within days. Recovery of strength and sensation, particularly in severe cases, may take longer. Your surgeon will discuss realistic expectations at consultation.
Surgery is generally recommended when: conservative treatment has not provided adequate or lasting relief; symptoms are severe or constant; nerve conduction studies show significant slowing; there is thenar muscle wasting; or when there is risk of progressive nerve damage. Early surgical treatment in moderate-to-severe CTS gives better outcomes than prolonged conservative management.
Other hand surgery services
Our specialist plastic surgeons
Carpal tunnel release at Coastal Plastic Surgery is performed by our FRACS-qualified specialist plastic surgeons, who have training and experience in all aspects of hand surgery.
Common questions about carpal tunnel syndrome
Carpal tunnel release is a short day procedure taking approximately 15–20 minutes under local anaesthetic. You will go home the same day. The operation involves a small incision in the palm and division of the transverse carpal ligament to permanently release pressure on the median nerve. A dressing is applied, and you will be discharged with instructions on hand elevation and wound care.
Night symptoms — numbness and tingling that wakes you from sleep — often resolve within days of surgery. Pain and daytime tingling typically improve quickly too. Recovery of strength and sensation in the thumb and fingers takes longer, particularly in patients who have had significant nerve compression or thenar muscle wasting before surgery. Full recovery of grip strength can take several months. Your surgeon will advise on realistic expectations at your consultation.
For mild to moderate carpal tunnel syndrome, non-surgical treatment — particularly night splinting and steroid injection — can provide significant symptom relief. However, non-surgical treatments do not address the underlying nerve compression and symptoms often recur. For moderate-to-severe CTS, or where conservative measures have failed, surgery is generally recommended as it provides long-lasting relief and prevents progressive nerve damage. Your surgeon will discuss the most appropriate approach for your severity of disease.
Most patients can use the hand for light activities within a few days of surgery. The dressing is typically removed at 10–14 days when the wound has healed. Return to office-based or light work can occur within 1–2 weeks. Return to manual or heavy work typically takes 4–6 weeks. Grip strength and fine motor function continue to improve over several months. Hand therapy is sometimes recommended to optimise recovery.
Carpal tunnel recurrence after surgery is uncommon. The vast majority of patients experience long-lasting relief following carpal tunnel release. In a small number of cases, scar tissue forms around the median nerve and symptoms may recur — this can be addressed with revision surgery if required. Incomplete release at the initial operation is a recognised cause of persistent symptoms and is usually managed with revision surgery.
Yes — carpal tunnel release is a medical procedure that attracts a Medicare item number. Applicable rebates will be included on your formal quote following consultation. If you have private health insurance, it may contribute to theatre and hospital costs. Most patients have carpal tunnel release performed under local anaesthetic as a day procedure in our rooms, which significantly reduces costs. Your surgeon will discuss costs at consultation.
Suffering from carpal tunnel symptoms?
Book a consultation with our specialist plastic surgeons at our Erina practice to discuss your symptoms and find out if carpal tunnel release is right for you.