Carpal Tunnel Syndrome
The carpal tunnel syndrome is the most common compressive neuropathy of the upper extremity. It is a result of compression
of the median nerve. The first symptoms usually appear after the age of 50.
Chronic compression results in damage of the nerve, disturbing conduction of neural impulses. The most common symptoms include: paresthesia (tingling and numbness), decreased sensation and pain ailments of the palmar surface of digits I-III and up to mid digit IV. Grasp weakening of the hand, manifesting in the form of dropping grasped objects, is another but rarer symptom. Aggravation of symptoms at night, frequently waking the patient up, is typical for the carpal tunnel syndrome. Chronic, untreated carpal tunnel syndrome results in irreversible changes in the structure of the median nerve.
In cases of carpal tunnel syndrome with mild, short-term symptoms, it is recommended to attempt non-surgical conservative treatment. It includes hand unloading, use of splinting and rehabilitation. If the above methods are ineffective or if the pain ailments are severe, the procedure of choice is surgical treatment.
FREQUENTLY ASKED QUESTIONS
The result of the specialised physical examination is of key importance. Existence of severe symptoms characteristic for the carpal tunnel syndrome is the most important factor qualifying the patient for surgical treatment. In certain cases, it is indicated to carry out imaging examination (ultrasound, X-ray) and electrodiagnostics (EDX examination) of the hand.
The purpose of surgical treatment is incision of the transverse carpal ligament, resulting in unloading the compressed median nerve in the carpal tunnel. The procedure can be performed using the classic open approach or endoscopic approach. The classic method consists in making a 5 cm incision of the palm surface of the hand. The other method involves performing the surgery under control of an endoscope inserted through a ca. 2 cm hand incision. Both types of procedures are performed under local anaesthesia of the hand.
Each of the available treatment options is discussed in detail during the pre-operative consultation. Both surgical techniques are characterised with similar treatment results. The superiority of the endoscopic technique consists in the shorter period of recovery of the hand operated on, thus allowing to resume sport and professional activities sooner. In most clinical cases, both these methods can be applied.
It must be emphasised that the purpose of the surgical treatment is not repair of the nerve damaged as a result of long-term compression, but creation of optimal conditions for its regeneration. In advanced forms, nerve damage can be so extensive that improvement might be minor and the benefit of the procedure will consist in inhibition of the disease progress. During the pre-operative consultation, based on the physical examination and additional tests, I inform the patient about the extent od expected treatment results.
In a definitive majority of cases, surgical treatment provides very good results. Usually, the patient notices subsiding of hand pain ailments related to the carpal tunnel syndrome already on the first day. This results from unloading of the compressed nerve. Whereas, improvement of sensation and subsiding of the paraesthesia (numbing, tingling) depends on the nerve self-repair process that can take from several to several dozen months.
It is very important to comply with the post-operative indications. Sparing the hand operated on is key factor. In case of an advanced form of the disease, rehabilitation is also indicated.
The achieved surgery results are mostly permanent. Research shows, however, that disease relapse is possible in a low
percentage of patients. This regards mainly patients who failed to observe post-operative indications, sustained injuries of the hand operated on or suffer from a number of other diseases. Disease relapse requires performing another surgery.
The procedure is performed in a one-day mode. After the procedure, the patient is under observation of qualified medical
personnel for a short time. In case of no contraindications, the patient is discharged from the clinic with post-operative
recommendations.
Elevation of the hand operated on is recommended for 2 weeks after the procedure. Sometimes, it is recommended to also
immobilize the hand in a splint. Swelling and slight tenderness of the hand may persist for several days after the procedure. Any potential pain ailments are mild and can be treated with OTC pain relievers.
Intensive hand rehabilitation is recommended in the post-operative period. In the case of the classic open approach, work can be usually resumed after 8-10 weeks for heavy labour duties and after 4-6 weeks for office jobs. If the endoscopic method is selected, resuming light work is possible already 3 weeks after the procedure.
The procedure entails a small palm incision. The post-operative scar becomes almost invisible after several months.