Carpal tunnel syndrome

In case of carpal tunnel syndrome, there is a narrowing under the transverse ulnar ligament in the wrist canal (carpal tunnel). In addition to flexor tendons of muscles of the hand and fingers, there is also a nerve that innervates the hand: the median nerve. A thorough clinical and also device-assisted examinations (electrophysiological examination/MRI if indicated) can help diagnose a bottleneck that affects the median nerve.

Carpal tunnel syndrome emerges in middle and higher age, and more frequently women are affected. But the carpal tunnel syndrome is also to develop earlier, for example, during pregnancy.

Symptoms carpal tunnel syndrome

A typical symptom of the carpal tunnel syndrome is the nightly falling asleep of one or both hands, also called paresthesia. Progressive symptoms of carpal tunnel syndrome are the permanent sensation disturbance in finger 1 to 3 and later thenar muscle atrophy. Here are the symptoms of the carpal tunnel syndrome in an overview:
•    one or both hands fall asleep (paresthesia)
•    sensation disturbance in finger 1 to 3 (thumb to middle finger)
•    thenar muscle atrophy

Causes carpal tunnel syndrome

The carpal tunnel syndrome is likely to be hereditary, but it is also caused by a multitude of factors, for example, chronic thickening of tendon sheaths or hormonal changes.

The narrowing that brings about the carpal tunnel syndrome can be caused by

• thickening of ligaments
• injury, bone fracture
• wear and tear (degenerative changes)
• metabolic disorders
• space-occupying lesions
• pregnancy

Diagnostics carpal tunnel syndrome

The Carpal tunnel syndrome is normally diagnosed by measuring the electrical conductivity of the nerves. The surgical therapy of the carpal tunnel syndrome in time makes a permanent cure possible. The disease has to be differentiated from a disc herniation in cervical spine.

Therapy carpal tunnel syndrome – carpal tunnel surgery

The carpal tunnel syndrome can be treated by microsurgery, a so-called carpal tunnel surgery. Drugs supporting the clotting of blood are to be stopped or substituted before surgery, if necessary after consulting the family doctor. Patients must have an empty stomach (this comprises eating, drinking and smoking). After surgery it is not possible to drive the car by oneself but to let another person drive you.

Carpal tunnel surgery can be done as an outpatient using regional anesthesia plus optional sedation (‘twighlight sleep’). Aim of the operation is to relief the median nerve by opening the wrist canal (carpal tunnel). During this procedure, a soft-tissue-like ligament (retinaculum flexorum) is cut through.

Complications (general/special) carpal tunnel surgery

After the surgical treatment of the carpal tunnel syndrome, small hematoma and swellings decrease quite quickly through active finger gymnastics and loosening of bandages. In case of severe swellings, several ice packs are to be applied in addition to loosening of bandages. But the wound has to be kept dry and must not get wet. In rare cases, a temporary worsening of nerve functions can occur after carpal tunnel surgery.
The inflammation or infection rate after the surgical therapy of the carpal tunnel syndrome is very low. Given signs of infection like pounding pain in the surgical area, reddening or festering of the wound, a doctor has to be consulted immediately. The best is to come to Beta Klinik instantly.
Theoretically, a damage of the median nerve during surgery is possible but has never occured in our practice. Extremely rare is the emergence of a sympathetic reflex dystrophy, also called complex regional pain syndrome (CRPS).

A slow or missing recovery of the nerve is often due to a too late surgery. If the carpal tunnel syndrome has caused sensation disturbances a long time before surgery, sensation disturbances can also need a long time up to month to go away. A new clamping of the nerve, a so-called recurrent carpal tunnel syndrome, is very rare.

Aftercare carpal tunnel surgery

After carpal tunnel surgery, a few things have to be considered. To avoid a swelling of the hand and to recover quickly, the hand has to be positioned at chest height and strains are to to be refrained from. A sling is not necessary. From surgery date, an active gymnastics of the affected hand is required. Patients have to clench their fists but also stretch their fingers completely several times an hour.
On first day after carpal tunnel surgery, the bandages are changed by the attending or the family doctor. Given surgery on Friday, cange of bandages is done the next day by the patient and his relatives, at least on Monday by the family doctor. Slowly, the hand can be increasingly strained. After 7-10 days, stitches are removed and washing hands and showering is possible without protective gloves. The hand can be regularly used for daily and most occupational activities after 2-3 weeks. A certain feeling of pain in the palm of the hand – the younger the patients the more often – has to be accepted. The complaints normally vanish almost completely after weeks and are not subject to the surgical procedure.

Caution!

If unexpected and unusual symptoms occur after carpal tunnel surgery, for exapmle, severe pain, mobility limitations of joints or severe swellings, please visit Beta Klinik immediately.