Carpal Tunnel Syndrome

01.04.2020

Definition/Formation

Carpal tunnel syndrome is the most common nerve compression syndrome. The median nerve (middle nerve) supplies the motor nerve stimulation to the thumb, index finger, middle finger and half of the ring finger. Together with all flexor tendons, it runs through a natural constriction of the wrist, the carpal tunnel. This anatomical tunnel is contained at the base and the sides by the carpal bones and a strong ligament forms the roof.

Causes

An increase in the volume of the carpal tunnel (e.g. thickening of the flexor tendons due to tendonitis) or a decrease in volume (e.g. bruising if the radius is fractured) increases the pressure on the median nerve. Systemic diseases (e.g. diabetes mellitus) or pregnancy can also increase the likelihood of carpal tunnel syndrome.

Symptoms

As a result of the pressure increase, most patients initially complain of numbness and tingling in the thumb and index / middle finger, only at night. Relief typically occurs after shaking hands. Over the course of time, the numbness of the fingers can also occur during the day or never disappear completely. At a very advanced stage, the muscles at the base of the thumb waste away (arrow).

Examination

If such symptoms are present, a neurologist should conduct a clinical examination and measure the nerve conduction speed. Depending on the severity of the findings, conservative measures (night positioning splints) may initially be considered or a carpal tunnel release surgery will be recommended.

Surgical Procedure

The procedure is carried out under local anesthesia on an outpatient basis (exception: surgery on both hands at the same time (requires 2 days in the hospital). After making a skin incision of 2-2.5 cm on the palm of the hand, the carpal tunnel is exposed with special instruments. Using a sophisticated knife that slides on a track (to protect the nerves from injury) the carpal tunnel is released. After that, only the skin is sutured. There is usually no necessity for a drain and immobilization in a splint is not required. Operating time: approx. 20 minutes.

Risks/Temporary Limitations

Risk of infection: less than 1%
Likelihood of damage to relevant vessels/nerves: less than 1%
It takes about 6 weeks to regain full strength
A hyper-sensitive scar and thumb/small finger bumps: 5-10% (duration: up to ½ year)
Excessive scarring: depending on individual wound healing tendency

Follow-up Treatment

If the wound heals without complications, your family doctor can carry out regular wound checks and stitch removal 14 days after the operation. A splint is not necessary and you can begin using your hand immediately after the anesthetic induced numbness has subsided. Avoid contact with water and weight-bearing loads (lifting heavy objects). Experience has shown, however, that already on the first day after the operation most patients report a significant reduction in the number of complaints that previously existed, e.g. can hold cutlery and get dressed without help.

Back to selection