Carpal Tunnel Syndrome

Carpal tunnel syndrome is the pressure of the median nerve in the wrist area, when it enters the palm. (Fig. 1.) The nerve is located between 9 tendons and is covered by a ligament. Possible consequences are numbness in the fingers, pain in the palm and muscle weakness of the hand. At first, the symptoms are relatively mild and appear only during sleep and for this reason, patients do not pay much attention.

Narrow tube: 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.

Pressure on the hand. People who practice a manual profession are affected 3-7 times more often by carpal tunnel syndrome. For example, workers who operate machines, cleaners and those who work long hours on the computer, are typical groups of patients who develop carpal tunnel syndrome.

Injuries: Injuries to the wrist area, such as a fracture, can cause carpal tunnel syndrome.

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

Rheumatoid arthritis: The  inflammation of the joints and tendons, presented by patients with rheumatoid arthritis, causes carpal tunnel syndrome in 50% of them.

Renal failure: Patients undergoing dialysis are more likely to have carpal tunnel syndrome.

Metabolic diseases-disorders: Patients who suffer from diabetes, hyperthyroidism, obesity, or women during pregnancy, have a higher risk of developing carpal tunnel syndrome.

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 the one that is pressed in carpal tunnel syndrome, is responsible for the neurosis of the thumb,  of the index finger, the middle and the outer side of the middle finger.

Pain: Initially, the pain occurs after a similar load on the hand, either, after manual work or after prolonged use of a computer. If the syndrome remains untreated, then the pain occurs without strain on the hand.

Inability to hold objects, clumsiness of movements: The patient is unable to make subtle movements with his fingers, such as buttoning his buttons or putting a key in the lock, while objects often fall out of his hand.

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 carpal tunnel stage with the formation of a characteristic pit in the palm. This results in a significant decrease in thumb strength, which significantly limits the patient’s daily activities.

The first step in diagnosing carpal tunnel syndrome is to get a good history from the patient. The aim is to investigate the subjective symptoms and the concomitant diseases from which he may suffer.

This is followed by a detailed clinical examination, where the mobility and sensitivity of the hand are checked, while special clinical tests (Tinel-Phalen test) are also used to make a diagnosis.

From a laboratory point of view, an upper limb electromyogram is required to confirm the diagnosis, which is a quick and reliable examination and safely establishes the diagnosis of the syndrome.

In the early stages of the syndrome, surgical treatment is not necessary. It is recommended to use a removable splint during sleep and to modify the load on the hand, when possible. When the cause of the syndrome is inflammation, short administration of cortisone is recommended.

When is carpal tunnel syndrome surgery necessary?

In most cases, surgical treatment of carpal tunnel syndrome is necessary. Specifically:

• As long as the symptoms persist after 4 weeks of surgical treatment.
• When the numbness in the fingers worsens and the patient has severe pain during the night.
• When the electromyogram shows significant nerve involvement.

How is the surgery for carpal tunnel syndrome performed?

For the decompression of the median nerve in carpal tunnel syndrome, an incision of just 2 cm in the palm area is required. (Fig. 3.) Through this incision, the junction that presses on the nerve is cross-sectioned. The operation that lasts 10 minutes, is performed either, under local anesthesia or light sedation and the patient can return home after 2 hours.

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