Carpal tunnel syndrome

In carpal tunnel syndrome, pressure occurs on the median nerve ( nervus medianus) in the carpal tunnel at the base of the hand, just below the palm.

Carpal tunnel or carpal canal are linguistic variants on the same topic, and refer to the anatomy of the hand itself and its tendons, blood vessels, and nerves.

All the tendons that allow the fingers to grasp and touch pass through a relatively narrow tunnel. This tunnel is made up of the bones of the wrist on one side and a stiff ligament called the transverse carpal ligament on the other. In addition to the tendons, nerves and blood vessels pass through the same tunnel, which causes quite a bit of crowding in the ‘small space’.

The median nerve is a combined sensory-motor nerve that carries information from most of the fingers to the brain, but also controls some muscles in the hand and fingers, including the thumb. Pressure on it can be caused by a number of processes, as well as constant repetitive movements of the fingers and hand, which cause fluid to accumulate within the narrow carpal tunnel, and over time, inelastic connective tissue and thickening of the tendons. All of this leads to a narrowing of this space where the median nerve is most sensitive, and damage occurs.

Although the specific causes of this syndrome are not precisely defined, it is assumed that most are caused by a genetically inherited narrow carpal tunnel (a narrow space through which tendons and nerves pass).

Mechanical pressure on the nerve can occur as a result of post-traumatic conditions in the area or due to anatomical anomalies. Furthermore, occupational injuries, hormonal changes during pregnancy or menopause, degenerative changes in the joints, tenosynovitis (inflammation of the tendon sheath), and systemic diseases such as rheumatoid arthritis are some of the additional causes of this syndrome.

Symptoms

Symptoms begin with a temporary tingling sensation in the fingers, most often at night or in the morning after waking up. They develop gradually and slowly, but over time these occasional symptoms can spread throughout the day, causing numbness in the fingers and the entire hand. Swelling of the thumb or all fingers may develop, along with possible pain. In a later stage, muscle weakness develops, resulting in a weakened grip, which over time, in an advanced stage, can turn into an inability to grip the hand. Patients complain of unsteady grasping of objects and objects falling out of their hands.

Treatment can be conservative and surgical.

Conservative treatment includes the use of non-steroidal antirheumatic drugs such as Aspirin, Voltaren and Ibuprofen in combination with physiotherapy. They mostly lead to a temporary solution to the problem, and after some time patients decide to undergo surgery, which is the only permanent solution.

The operation is based on a minimally invasive surgical technique that we use at our Polyclinic, during which the ligament that forms the arch of the carpal tunnel is cut. This achieves decompression of the carpal tunnel, i.e., the pressure on the median nerve is removed, which in most cases permanently solves the problem and eliminates symptoms.

Carpal tunnel syndrome is associated with certain occupations, which is why it is more common in hairdressers, physiotherapists, masseurs, typists, tailors, construction workers, and some other professions. It also occurs frequently in people who work a lot on computers, which is where the name ‘computer hand’ or ‘computer disease’ comes from.

The disease occurs significantly more often in women than in men, especially between the ages of 40 and 50.

Ideal candidates are those who start treatment in the early stages of this disease. Therefore, at the first appearance of symptoms and suspicion, it is necessary to conduct a clinical and diagnostic examination. Clinical examination at the Bagatin Polyclinic is a consultation with a surgeon. If the surgeon suspects carpal tunnel syndrome based on the symptoms, the patient is recommended to go to a facility where a specialist neurologist can perform an EMNG examination. EMNG is a diagnostic examination that will objectively show whether the patient has the aforementioned syndrome. If necessary, a broader examination is recommended, which may include radiological examination (X-ray), carpal tunnel ultrasound, laboratory tests, CT, MRI, and other examinations. If carpal tunnel syndrome is proven, treatment should be started as soon as possible.

The length of recovery, as well as the final result of treatment, will depend on the previous duration of the disease, i.e. the symptoms (before surgery).

During the consultation, the doctor at the Bagatin Polyclinic will obtain all the necessary information from you about your symptoms and, during the clinical examination, will determine whether there is a sensitivity disorder (sensation), motility disorder (movement) or hand muscle atrophy.

You will also be explained the further diagnostic work-up that you will need to undergo before the surgery. Bagatin Polyclinic does not perform the diagnostic tests necessary to prove this condition, but your doctor will recommend institutions where you can have certain tests done.

In the first place, it will be sufficient to have an electrodiagnostic test (EMG) performed by a specialist neurologist, which shows the location of the nerve compression and the speed of nerve conduction through the forearm. Other diagnostic tests may include basic radiological testing (X-ray), carpal tunnel ultrasound, laboratory tests, CT, MRI, and other tests.

After an accurate diagnosis is made, a date for the procedure is determined.

One week before and one week after the surgery, it is necessary to avoid medications that reduce blood viscosity (Warfarin, Martefarin, etc.; consult your general practitioner about these medications if you are taking them) and medications from the group of anti-inflammatory drugs that contain acetylsalicylic acid (Aspirin, Andol, Acisal, etc.).

On the day of the procedure, it is not recommended to use shower preparations that oil the skin, but ordinary soap or shower gel.

The surgical procedure – open decompression of the medial nerve in the carpal tunnel – is performed on an outpatient basis in day surgery, meaning that the patient goes home after the procedure. It is performed by a surgeon using minimally invasive techniques and the most modern medical equipment.

The procedure is performed under block anesthesia (a type of local anesthesia) and lasts only about 20 minutes.

The procedure is performed by an experienced doctor in the so-called blood path (bloodless technique), along with visualization of the nerve, i.e., magnification up to 3.5 times under magnifying glasses (operating glasses), which guarantees safety and the best result.

The surgery itself is performed through a short, longitudinal surgical incision, about 1 cm long, at the base of the palm below the wrist (Figure 2). The procedure is based on cutting the carpal ligament that forms the arch of the carpal tunnel (Figure 1, above). Cutting the ligament removes pressure from the nerve and relieves the patient of the pain and numbness he or she felt before the procedure. After the nerve is relieved of pressure, the wound is sutured and the palm is wrapped and bandaged.

After the procedure, the hand is wrapped in bandages, and finger movements and occasional use of the hand are allowed. During this period, it is recommended to rest the hand, with the hand in an elevated position. At the first check-up, the first day after the procedure, the amount of bandage material is reduced, and the surgical wound is covered with a special dressing that protects the wound and contributes to faster healing. Check-ups are mandatory every 2-3 days in the first 10 days after the procedure, in agreement with the surgeon. The stitches are removed after 2 weeks, followed by a short period of outpatient rehabilitation and physical therapy, after which the patient is able to work again.

Paresthesia (impaired sensation) and numbness in most cases disappear within the first day after surgery, but it is possible that your fingers will still be numb for a short time after the procedure, depending on the degree of pressure on the nerve and the symptoms you were experiencing before the procedure.

For the first three days after the procedure, you may feel some pain in the incision area. To keep the pain as mild as possible, you will be given painkillers and instructions for their use after the procedure. The medical staff at Bagatin Polyclinic will ensure that your recovery is as quick and painless as possible.

Once your doctor removes the stitches, along with regular physical therapy, you will be able to use your hand more and more day by day. Recovery time is individual and depends on the degree of nerve damage. In most patients, with appropriate rehabilitation, grip strength in the hand and fingers returns within 3 months.

Sometimes it takes several months for the nerve to fully recover and all symptoms to disappear, while complete recovery of electroneurophysiological parameters takes 4 to 10 months.

It is recommended to apply moisturizing creams to the scar on the palm of your hand for 6-8 weeks after the procedure.

Complications are rare, but possible despite the measures taken. At the Bagatin Polyclinic, we take all precautions to minimize all possible risks. However, you are also responsible for avoiding risks and complications. For three weeks after the operation, it is not recommended to lift objects or make sudden movements with your hand. Your hand should be kept elevated – if you are lying down, keep it on pillows, and if you are walking, let it rest on the shoulder of the opposite hand.

Also, in order for the wound to heal without complications, it is necessary to avoid activities that can contaminate and infect it.

The doctor at the Bagatin Polyclinic will inform you about all complications and precautions during the consultation.

Recovery can sometimes be very slow (6-12 months) with a slightly uncomfortable feeling in the fingers as the nerve grows back.

In cooperation with banks, Bagatin Polyclinic provides the option of paying in installments, as well as interest-free payments up to a certain number of installments.

You can check more about payment methods and the cost of the procedure in the current price list of the Bagatin Polyclinic:

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