What is carpal tunnel syndrome?
Carpal tunnel syndrome is a common disease that belongs to the group of diseases - compression neuropathy. As the name suggests, the cause of the symptoms (tingling and pain in the hands) is the imprint of the nerve in the carpal tunnel at the base of the hand. The carpal tunnel is a narrow tunnel through which the median nerve (Latin nervus medianus) passes along with the tendons of the fingers. The canal is formed by the bones of the base of the shelf and the carpal ligament.
Why does a nerve imprint form?
During life, the tendons in the carpal tunnel and the carpal ligament gradually thicken (hypertrophy), leaving less and less room for the nerve and, as a result, it can gradually become compressed. The imprint of the nerve causes the characteristic manifestations of the disease. Although anyone can get carpal tunnel syndrome, it is more common in people whose work involves a lot of hand strain - work on a conveyor belt, computer, handicrafts, agricultural work and others. Carpal tunnel syndrome is 4 times more common in women than in men.
It is also more often observed in people with metabolic and hormonal imbalance disorders, diabetes patients, patients with weakened thyroid function, rheumatoid arthritis. Often, carpal tunnel syndrome develops in pregnant women in connection with hormonal changes, in this case, it usually disappears after pregnancy.
How carpal tunnel syndrome manifests
Carpal tunnel syndrome manifests as:
- progressive tingling and pain in the hands, especially at night;
- swelling, numbness in the fingers in the morning;
- usually the first to get sick is the leading hand (the one with which you work the most on a daily basis)
If the disease is ignored for a long time and is not treated, later joins:
- movement disorders in the hands, arm weakness;
- inability to grasp and hold small objects.
A long-term untreated nerve imprint can lead to irreversible nerve damage and radically worsens the quality of life - finger sensation disorders become more and more pronounced, the muscles of the hand wear out over time, the hand loses strength and the ability to perform even simple daily tasks is lost. In more severe cases, the ability to work is completely lost and disability may occur.
What to do if you suspect carpal tunnel syndrome?
Since tingling in the hands and arms can have different causes, a neurosurgeon or neurologist should be consulted in order to determine the cause of the tingling and initiate appropriate treatment. In order to choose the most appropriate treatment method that relieves pressure on the nerve and promotes the regeneration of damaged fibers, it is first necessary to specify the location and degree of nerve damage.
How is carpal tunnel syndrome diagnosed?
The diagnosis is based on typical complaints (symptoms);
- signs of the disease that the doctor can detect during the examination (nerve compression test, wrist muscle wasting, etc.)
- neurography - an examination with the help of which the depth and location of nerve damage can be determined;
How is carpal tunnel syndrome treated?
Carpal tunnel syndrome is treated by a neurosurgeon. The main task of treatment is to reduce/prevent nerve compression. Depending on the degree of nerve damage, there are several options.
- Medicinal therapy. In milder cases, drug therapy with local steroid injections (blockades) is used. The blockade reduces the edema of the tissues around the nerve, thus the nerve becomes more spacious and the symptoms disappear, however, when the blockade effect ends (usually 6-12 months), the symptoms most often return.
- Orthotics – since the pressure on the wrist nerve is the least in the neutral position, in mild and moderate cases, putting on the Chrisofix wrist orthosis (Working orthosis for carpal tunnel syndrome) at night, as well as while working, helps. Keeping the wrist in a neutral position protects the nerve from irritation/impression in the event of involuntary wrist flexion during sleep or work.
- Surgery is the most effective and definitive treatment for carpal tunnel syndrome. Since the essence of the disease is a pinch on the nerve, the goal of the operation is to release the nerve from the pinched state, which is achieved by cutting the carpal ligament. The operation is short and easy to tolerate, it is performed under local (local) anesthesia - similarly to the dentist. Shortly after the operation, the patient can go home. Either the traditional surgical method or the newer and much less traumatic endoscopic method is used to release the nerve.
Traditional surgical/conventional surgery is performed under local anesthesia. At the base of the palm, perform approx. 2-3 cm cuts in the skin, open the channel and release the nerve from the imprint. After the operation, a sparing regimen should be followed for one month.
The endoscopic method is much gentler for the patient. Through a small incision in the skin, a miniature endoscope (medical video camera) is inserted into the carpal tunnel and, using fine surgical instruments, the carpal ligament is redistributed, thereby releasing the pinched nerve.
Compared to the traditional surgical method, the endoscopic method has a number of advantages - the surrounding tissues are maximally spared, thus the recovery and restoration of working capacity is significantly faster, and there are practically no cosmetic defects. It is especially important to use the endoscopic method in patients with difficult wound healing - patients with diabetes, vascular diseases.
Recommendations after surgery include the following:
- painkillers as needed (usually needed once - overnight on the day of surgery);
- wound dressing on the first postoperative day (further dressings are not necessary, provided that there is no discharge from the wound);
- suture removal 14 days after surgery;
- spare the operated arm (do not overload) for 3-5 weeks.
- it is also recommended to use a wrist orthosis/work orthosis for the carpal tunnel for the first 2-3 weeks, as well as in cases where the patient needs to do relatively light work (e.g. work with a computer keyboard).
What is the prognosis of surgery?
In general, the prognosis for treatment of carpal tunnel syndrome is very good:
90% of patients manage to completely cure the disease and/or achieve significant improvement.
The result of the operation depends on how long the nerve was compressed. Therefore, it is important to consult a doctor in time.
The operation provides a long-term result - the opportunity to work and sleep normally again.
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