Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is the pressure of the median nerve in the wrist area as it enters the palm. (Fig. 1.) The nerve is located among 9 tendons and is covered by a ligament. It usually causes numbness in the fingers, pain in the palm and muscle weakness in the hand. At first, the symptoms are relatively mild and appear only during sleep and for that reason the patients do not pay special attention to them.

 

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Causes & Risk Factors

Narrow carpal tunnel: There are patients who, from an anatomical point of view, have a narrow carpal tunnel. These patients are more likely to develop the syndrome. A typical example is women, in whom carpal tunnel syndrome occurs 3 times more often than men.

Hand strain. Manual workers are affected 3-7 times more often by carpal tunnel syndrome. For example, machine workers, cleaners, and those who work with computers for many hours are typical groups of patients with carpal tunnel syndrome.

Injuries: Wrist Injuries, such as a fracture, can cause carpal tunnel syndrome.

Inflammation: Inflammation of the tendons around the nerve can put pressure on it and lead to the syndrome.

Rheumatoid arthritis: Inflammation of the joints and tendons, which appear in patients with rheumatoid arthritis, causes carpal tunnel syndrome in 50% of them.

Renal failure: Patients undergoing haemodialysis are more likely to develop carpal tunnel syndrome.

Metabolic disorders: Patients with diabetes, hyper or hypothyroidism, obesity, or women during pregnancy are at higher risk for developing carpal tunnel syndrome.

Symptoms

In the early stages the symptoms are mild and patients do not pay much attention. If the nerve remains under pressure for a long time, the chances of permanent neurological damage increase dramatically.

Early symptoms of carpal tunnel syndrome

Numbness in the hand: A characteristic symptom of carpal tunnel syndrome in the early stages is numbness in the hand during sleep. Later the numbness turns into pain and the patient wakes up and tries to move his hand. The median nerve, which is pressed in the case of carpal tunnel syndrome, is responsible for the nerves of the thumb, forefinger, middle and outer side of the middle finger. (Fig. 2)

Carpal Tunnel Syndrome. Detection of neurological symptoms (numbness)

Pain: Initially pain occurs after hand strain, either for example after manual work, or after prolonged computer use. If the syndrome is not treated, then the pain appears even without straining the hand.

Inability to hold objects, awkward movements: The patient is unable to make fine movements with his fingers, such as buttoning or putting a key in the lock, and often objects fall from his hand.

Advanced stage

Loss of sensation: If the nerve remains under pressure for a long time, then the patient experiences loss of sensation in the affected fingers.

Atrophy of the thumb muscles: The thumb muscle, which is innervated by the median nerve, shows characteristic atrophy in the advanced stage of the carpal tunnel syndrome with the formation of a characteristic cavity in the palm. This results in a significant reduction of thumb’s strength, which limits the patient’s daily activities to a great extent.

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Carpal Tunnel Syndrome: Diagnosis

The first step in diagnosing carpal tunnel syndrome is to take an accurate history from the patient. The aim is to investigate the subjective symptoms and comorbidities from which he may be suffering. Then follows a detailed clinical examination, where the mobility and sensation of the hand are checked, while specific clinical tests are also used (Tinel-Phalen test) for the diagnosis.

Regarding laboratory tests and in order to confirm the diagnosis, an upper limb electromyogram is required, which is a rapid and reliable examination that safely establishes the diagnosis of the syndrome.

Treatment – therapy

In the early stages of the syndrome, surgical treatment is not necessary. It is recommended to use a removable splint during sleep and trying not to putting the hand under strain if possible. When inflammation is the cause of the syndrome, short-term cortisone therapy is recommended.

When surgical treatment of carpal tunnel syndrome is necessary?

In most cases, surgical treatment of carpal tunnel syndrome is necessary. In particular:
  • When the symptoms persist after 4 weeks of conservtive treatment
  • When the numbness in the fingers worsens and the patient has severe pain during the night.
  • When the electromyogram shows a significant nerve injury.

How is the surgery in carpal tunnel syndrome performed?

To decompress the median nerve in carpal tunnel syndrome, an incision of just 2 cm in the palm area is required. (Fig. 3). Through this incision a cross-section of the ligament that presses the nerve is taking place. The operation lasts 10 minutes either with local anesthesia or mild sedation and after 2 hours the patient can return home.

 

Carpal tunnel syndrome – Surgical incision

Post surgery rehabilitation

Post surgery rehabilitation for carpal tunnel syndrome is extremely simple. The patient returns to full activity 2 weeks after the surgery, when the stitches are removed. Until then he can take care of himself without risk. Physiotherapy is required only when the surgical treatment has not been done in time and strengthening of the hand is necessary.

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Frequently asked questions

Do the chances of developing a carpal tunnel increase during pregnancy?

The incidence of carpal tunnel syndrome increases during pregnancy. This is due to the hormonal disorders that occur during pregnancy and the increased fluid retention. After pregnancy, the symptoms usually fade. However, there is a percentage of 20-30% where the syndrome persists and must be treated surgically.

What is the cost of surgery for carpal tunnel syndrome?

To find out the exact cost of the operation please contact our clinic.

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