What are good routes for carpal tunnel

Carpal tunnel syndrome is the most common nerve constriction in the hand.


The hand is supplied by three nerves. The median nerve - also called the middle nerve - is responsible for the feeling on the flexor side of the thumb, index and middle finger and the thumb-side half of the ring finger. In addition, it supplies a large part of the ball of the thumb muscles. If the nerve fails, the thumb can no longer be spread apart and can no longer be placed opposite the fingers. The feeling in the named fingers is also missing.
At the level of the wrist, the median nerve runs through a canal (carpal canal) together with 9 flexor tendons. This canal is bounded on the flexor side by a ligament of connective tissue.


There are various symptoms associated with a narrowing of the middle nerve in the hand, the so-called carpal tunnel syndrome. So you feel a weakness in the hand as well as a stiffness of the fingers. Sensory disturbances such as furiness and numbness or tingling of the fingers occur, which are accompanied by difficulty in closing buttons or holding objects. These symptoms are often aggravated when the hand is strained. In addition, the hand often falls asleep at night, so that the patient wakes up and has to shake the hand or hold it under cold water. Pain often extends from the wrist to the elbow, sometimes even to the shoulder. 50% of all carpal tunnel syndromes affect people between the ages of 40 and 60 years.

If you tap the wrist on the flexor side, electrification is often triggered. Tingling in the fingers is also common when the wrist is bent or stretched too much. A regression of the ball of the thumb suggests an advanced carpal tunnel syndrome.
In addition to these “clinical signs”, carpal tunnel syndrome can also be diagnosed by measuring the conduction velocity of the nerves. This examination is carried out by a neurologist (neurologist). However, 15% of all carpal tunnel syndromes show no change in nerve conduction velocity.

The causes of the constriction can be a chronic irritation with thickening of the tendon sheaths, a tendency of the tendon tissue to swell during pregnancy and rheumatic diseases or injuries or tumors.

Carpal tunnel syndrome occurs more frequently in people with rheumatism, diabetes, thyroid disease and hormonal changes, such as during pregnancy or during menopause. Injuries to the hand or a broken wrist can also be a trigger.

Therapeutically, an attempt can initially be made to remedy the symptoms without surgery. You can rest your hand and wrist at night on a splint placed on the back of the hand. In addition, cortisone can be injected into the carpal tunnel once. If the carpal tunnel syndrome occurs during pregnancy, it often disappears spontaneously 2-3 months after delivery.

If there is no improvement, only an operation will help. This can be done either under anesthesia of the nerves, the whole arm or under general anesthesia. The procedure is carried out in a void of blood, for which the blood is unwound from the arm and a cuff placed on the upper arm is inflated, which remains inflated during the entire operation. The ligament that spans the nerves (retinaculum) is cut through a small skin incision in the palm of the hand over the carpal tunnel. In addition, thickened tendon sheath tissue can be removed. Often, however, no cause can be identified during the operation that is responsible for the constriction of the nerve.


Skin incision
Course of the median nerve under the retinaculum
Condition after splitting the retinaculum
to show the steps to during an operation
WHAT COMPLICATIONS MAY OCCUR?


Despite the greatest care, isolated disorders can occur during or after the operation, which may necessitate further treatment measures or follow-up operations.

If the nerve is injured, temporary or permanent abnormal sensations, numbness of the thumb, index, middle or ring finger as well as weakness of movement with weakness of the thumb can occur. However, these complaints can already be present as a result of the disease. They regress very slowly or not at all.


Very rarely, nerve and skin damage can occur due to the necessary storage or the lack of blood, which can be treated successfully in most cases and only in extremely rare cases leave permanent damage (e.g. numbness, painful discomfort, scars).


The hand may be swollen after the procedure. Even if the patient is consistently elevated, the bandage can become too tight. If the fingers are blue and / or numb, remedial action must be taken as a matter of urgency, otherwise permanent tissue damage may result.


Secondary bleeding and bruising occur due to the abundance of blood vessels in the operating area and can make reoperation necessary.


If the tendon sheaths are removed at the same time, the mobility of the fingers can be painfully restricted over a long period of time.


Occasionally, with the appropriate predisposition, thick, bulging, discolored and painful scars (scar growth, keloid) develop.


Occasionally, there is increased sensitivity to touch in the area of ​​the cut as a result of the severed nerve ramifications in the skin. This usually goes away on its own and usually does not require any treatment.


In exceptional cases, painful soft tissue swelling, coupled with a functional circulatory disorder (local feeling of heat and cold) is possible, which over a long period of time can lead to the breakdown of muscles and bone tissue as well as restricted movement and even stiffening of joints. This reflex dystrophy or Sudeck's disease urgently requires intensive special follow-up treatment.


Very rarely infections can occur, which may require reoperation and prolong the duration of treatment.
CAN THE OPERATION BE CARRIED OUT OUTSIDE?


After all risk factors have been excluded, the procedure can be carried out on an outpatient basis. If this is planned, please arrange for someone to pick you up afterwards and make sure that someone is at home for a certain period of time.

Please note the temporary restriction of your ability to react due to anesthetics, painkillers or narcotics. You are not allowed to actively participate in road traffic in the first 12-24 hours after the intervention, i.e. not drive a vehicle or two-wheeler, work on dangerous machines and not make any important decisions.


WHAT ARE THE PROSPECTS FOR SUCCESS?


The operation usually leads to a complete recovery of the nerve. The typical, mostly nocturnal pain no longer occurs in the first night after the operation. The less the nerve is damaged, the faster the feeling returns. Improvements are still possible up to six months after the operation.

Rarely does the constriction persist and thus the symptoms or the symptoms recur due to scarring (recurrence). Follow-up surgery may then be necessary.


DO YOU NEED AFTER-TREATMENT?


To ensure success, we depend on your help and the conscientious observation of the guidelines for follow-up treatment.

To avoid swelling, the hand should be consistently elevated or held up.
Start moving your fingers shortly after the operation!
Never let your hand hang down!
Even after removing the threads, the hand must be spared for some time!