Carpal Tunnel Syndrome

The frequent carpal tunnel syndrome is a narrowing of the median nerve (median nerve) on the flexor wrist with the result of sensory disorders on the thumb, index, middle and inner half of the ring finger, nocturnal pain and an increasing weakness. After the suspicion of a carpal tunnel syndrome has been confirmed by a nerve conduction velocity measurement, the nerve should be relieved quickly before permanent damage occurs.

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Carpal Tunnel Syndrome - Treatment directly with our orthopedic experts 2020-03-05 Carpal Tunnel Syndrome
More About Carpal Tunnel Syndrome

The carpal tunnel syndrome, abbreviated KTS or CTS (carpal tunnel syndrome), is the most common upper nerve limb syndrome. Nerve constriction syndrome is the term used when it comes to a pressure damage of a nerve due to constriction. This can develop acutely, but it usually develops gradually over a longer period of time. A carpal tunnel syndrome is a constriction of the arm medial nerve (nerve medianus) in the area of ​​the flexor wrist. At this point, the nerve, together with the superficial and deep finger flexor tendons and the long thumb flexor tendon through a tunnel (carpal tunnel), which is bounded by the carpal bones and a very tight band (retinaculum flexorum) is covered.

How to diagnose a carpal tunnel syndrome?

Now exists due to o.g. Complaints and clinical examination of suspected carpal tunnel syndrome, an electrophysiology examination should be performed. This is usually offered by a specialist in neurology or physical medicine. The examination can objectively determine whether and how severe a narrowing of the nerve is.

How to treat a carpal tunnel syndrome?

Depending on the degree of manifestation and the duration of the carpal tunnel syndrome, therapeutically different measures are used. With still a short complaint time first non-operative (conservative) treatments can be tried. Nocturnal immobilization on a support rail prevents flexion of the wrist and thus an additional pressure increase in the carpal tunnel.

In marked cases or with long-lasting complaints, only the operation remains. This is done gently and painlessly under local anesthesia. During operative treatment, the median nerve is released from its narrowing by completely severing the tight roof of the carpal tunnel, the flexor retinaculum. This widens the narrow carpal tunnel and reduces the mechanical pressure on the nerves. This is done via a mini-cut in the hollow hand. On a so-called empty blood, so the sometimes painful inflating a cuff on the upper arm is omitted. At the end of the operation we apply a thin protective bandage so that the mobility of the fingers is not restricted.

We ask our hand surgery experts: What happens if the carpal tunnel syndrome is not operated on?

Nerves are sensitive structures. Long-term pressure effects can lead to an increasing malfunction, which under certain circumstances can no longer be reversed. In addition to emotional disturbances, permanent weakness also causes weakness of the thumb due to shrinkage of the thumb muscles. It is therefore advisable in many cases not to wait too long for the operation.

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Latest News in Carpal Tunnel Syndrome

Carpal tunnel syndrome: numb and sore hands

22.09.2021

Everyone knows the tingling sensation or the numbness when hands or feet fall asleep. As soon as you move, this feeling usually disappears quickly. If you experience symptoms like this in your hands more often, you may have carpal tunnel syndrome: an entrapment of the metacarpal nerve in the wrist tunnel.

In carpal tunnel syndrome, there is chronic pressure damage to the median nerve that runs along the wrist and controls the movements of the fingers and thumb, among other things. This is due to a narrowing of the carpal tunnel, which occurs in families. “Women are about three times more likely to be affected than men. Patients who suffer from the syndrome initially usually experience symptoms such as hands falling asleep or numb fingers - initially mainly at night or towards morning. In the course of the day, the symptoms mentioned, abnormal sensations in the thumb to middle finger and later also pain also occur during the day, for example when making calls or cycling, ”reports Dr. Mohamed Arafkas, specialist in plastic and aesthetic surgery as well as hand surgery and chief physician at the Petrus Hospital in Wuppertal, Clinic Association St. Antonius and St. Josef. Over time, there could also be a decrease in the sense of touch, signs of paralysis and muscle wasting on the ball of the thumb.

If those affected suffer from the symptoms mentioned, they should consult a doctor. If carpal tunnel syndrome is detected early, it can often be treated without surgery. “If there is a suspicion, doctors do an examination of the electrical conductivity of the nerves, or NLG for short, to confirm the diagnosis. To do this, short electrical stimuli are sent through the arm via electrodes. With a healthy nerve, the muscles in the hand respond. If the conductivity is disturbed, however, this indicates the carpal tunnel syndrome. The subsequent treatment depends on the extent of the symptoms and depends on the duration of the symptoms, ”explains the specialist. In the early stages, the syndrome can often be treated by wearing a wrist splint that is put on at night. Sometimes cortisone, which is injected into the carpal tunnel and has a decongestant and anti-inflammatory effect, also helps.

If the treatments mentioned are not sufficient or if the paresthesia and pain persist, an operation will be necessary. The operation is usually carried out on an outpatient basis and under local anesthesia of the affected arm. Surgeons cut the carpal ligament over the carpal tunnel through a small incision in the palm of the hand, which gives the nerve more space. As a rule, the symptoms disappear and the hand function normalizes with physiotherapeutic exercises afterwards.

However, many patients only turn to a doctor when there is already severe damage to the nerve with constant numbness: “Even at this very advanced stage, surgeons can still perform the operation, but certain functions cannot always be restored,” says Dr. Arafkas. An early diagnosis and treatment increase the chances of recovery immensely.

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