The affected nerve (median nerve) is incarcerated through a ligament in the wrist region that stretches between the thenar and antithenar. It runs under the ligament together with 9 flexor tendons in a tunnel-like tube (carpal tunnel) in the hand. Due to the continuous pressure that is exerted on the nerve, nerve impairment occurs which clinically manifests in tingling fingers (mainly of the thumb, forefinger and the middle finger), nocturnal pains often spoiling sleep and numbness in the affected hand. Not rarely the afflictions extend beyond the wrist so that the pain can spread even to the upper arm and the shoulder/neck region. Shaking out or cooling the hand often brings short-term relief.
If the disease is present for a longer time, atrophy of thenar musculature can develop. Affected patients also report clumsiness and weakness of the hand. Carpal tunnel syndrome often occurs in both hands.
The cause of the disease is often unclear. In some cases the disease is evoked as the result of bone fractures with constriction of the carpal tunnel. Similarly, tumours in this region lead to nerve compression. Also diseases of synovial tendon sheaths, polyarthritis, gout or trigger finger can predispose to the disease. Additionally metabolic disorders and endocrinopathies are not infrequently accompanied by CTS. Women are affected approximately 3-4 times more often than men. Often women in the menopausal period become ill. Also other hormonal changes, e.g. pregnancy, can trigger these afflictions.
The exact description of the patient’s afflictions is essential.
The electrophysiological examination (ENG/EMG) can confirm the suspected diagnosis.
In the early stage of the disease conservative treatment is appropriate (applying for the night a positioning splint ). However, this and other measures, e.g. cortisone injection into the carpal tunnel, usually do not lead to permanent improvement of the afflictions, so one should not wait long with surgical measures in order to prevent permanent nerve damage.
Surgical treatment of carpal tunnel syndrome can be carried out as endoscopic or open surgery. We prefer an endoscopic procedure in our clinic. With the help of an endoscope a division of the flexor retinaculum of the hand by two small skin incisions (in the wrist crease region and in the palm region) is carried out under visual control of the video camera (Fig. 1). The intervention is carried out ambulatory as a rule. Local anaesthesia is applied for the operated area.
Also in a proper surgical technique there is a possibility of CTS re-occurrence. This can be induced by an intensified cicatricial reaction after the surgery. Other causes include strong adenoids of synovial tendon sheaths in patients suffering from rheumatism or dialysis patients. In the case of recurrence only an open surgical technique can be carried out with the application of a skin incision in the palm between the thenar and antithenar. Here division of the ligament is carried out.
On the day of surgery a compression dressing is placed, in order to reduce postoperative haemorrhage (if the dressing is too tight, please contact the attending physician immediately!). The dressing must not restrict the finger mobility and can be removed the next day. On subsequent days regular checks of the wound are carried out. On the 10th day after surgery the stitches are taken out. In the first 4-6 weeks the hand should not be stressed (it is particularly desirable to move the fingers). Clinical and electrophysiological follow-up after 3 months.
In most patients (98%) after surgery an immediate improvement of nocturnal pain takes place. If the pressure damage was present for long, the sense of numbness resolves slowly.