Peripheral Nerves

  >  Carpal Tunnel Syndrome
CARPAL TUNNEL SYNDROME

By the term Carpal Tunnel Syndrome we mean the trapping - compression of the median nerve in the carpal tunnel. The Carpal tunnel is defined by bones, ligaments, muscles and tendons that move the fingers, wrist and hand.



Course of  the disease

Initially dysesthesia and/ or pain especially with strenuous activities are observed. The symptoms improve with rest. The symptoms intensify with increased pressure on the nerve. When the pressure increases significantly the symptoms,  predominantly pain are maximized reducing the ability of the hand to grasp objects.

Symptoms :

  • Pain in the wrist which radiates to  the fingertips and even to  the shoulder and / or neck
  • Worsening of pain during the night or early morning. The patient wakes up in pain.
  • Abnormal sensations or tingling in the fingertips
  • Impaired muscle strength of the hand
  • Thenar Atrophy of  thumb muscles
  • Dry skin, swelling and pallor of the skin.

Diagnosis:

The symptoms are usually suggestive and guide the diagnostic method. Tinel and Phalen sign tests are done where pressing the median nerve causes a feeling of dysesthesia and bending the wrist for at least a minute causes a feeling of dysesthesia or paresthesia, respectively.

Electrodiagnostic testing is done with electromyography.

In rare cases,  MRI  of the wrist is necessary.

Treatment:

Each condition can be treated either conservatively or if this is unsuccessful, surgically.

  • A) Initially, patients will be given non-steroid anti-inflammatory medication and / or cortisone and painkillers. Cortisone may be injected percutaneously or locally by direct injection into the area of the wrist. At the same time a splint may be used during the night. Physiotherapy aimed at lengthening the ligament, electrotherapy and therapeutic ultrasound is often used in conservative treatment.
  • B) The surgical treatment entails lengthwise bisection of the ligament to safely release the median nerve . This is done either by incision posteriorly on the palm of the hand approximately 3-4 cm in length or endoscopically.