This is an area where the flexor tendons of the fingers run along with a large nerve that supplies the first to third fingers, including half of the fourth finger. It ensures not only sensitivity but also fine motor skills of the fingers. The roof of this canal is formed by a tough fibrous band that can thicken under certain circumstances and compress the structures beneath it, including the aforementioned nerve.
Carpal tunnel syndrome is one of the most common conditions affecting the hand and most often affects women. It is often caused by repetitive strain on the hand (heavy manual labor) and certain stereotypical activities (e.g., working with a keyboard and mouse). It is a condition where the nerve is compressed due to the aforementioned thickened fibrous band/roof of the canal, as well as thickened tendon sheaths of the flexors running inside the canal, whose space is narrowed as a result of these conditions.
Symptoms
- Sudden or gradually developing hand pain and "tingling" (numbness) of the fingers, which can occur during the day or at night
- Frequent waking and difficulty falling asleep due to discomfort
- Inability to perform certain activities, such as dropping objects from the hand, inability to button a button, inability to hold an object in the hand during fine activities
- Frequent hand stiffness, increased fatigue, swelling, and limited finger mobility (inability to fully bend fingers into the palm)
Cause
- Unilateral - strenuous work for the hand
- Congenital predisposition to a narrow carpal tunnel
- Pregnancy
Diagnosis
Surgical treatment is always indicated and recommended by a neurologist based on EMG examination.
Treatment
After unsuccessful conservative treatment (vitamin injections - B1, B12), surgical treatment is recommended. We do not recommend the application of injections (corticosteroids) into the canal due to their negative effect on the nerve and tendons. Additionally, at least a three-month break is necessary before surgery. The principle of surgical treatment is to interrupt the thickened fibrous band (ligament) and release the nerve from its thickened sheaths (neurolysis). Sometimes it is necessary to remove the thickened tendon sheaths (synovectomy), which, as mentioned earlier, can narrow the space inside the canal.
Basic information about the procedure
- It is an outpatient procedure
- The procedure is performed under local anesthesia (local numbing)
- The procedure takes about 30 minutes
Postoperative care
The day after the procedure, it is necessary to exercise the operated hand, and the patient is instructed on the exercises by the surgeon. A bandage on the hand is necessary for 2 weeks. After this period, the patient comes for a check-up to remove the stitches. The operated hand can be used for normal activities after 3 weeks from the procedure. For the next 2 to 3 months, it is necessary to avoid any strenuous use of the affected hand. The scar remains sensitive for several weeks after the surgery, but it will fade over time with massage. After the scar matures, the patient is without difficulties. After the procedure, the hand is in a sling for 2 weeks to keep it elevated.