Carpal tunnel syndrome (CTS)

What is a carpal tunnel?
The carpal tunnel is the tunnel-like passageway that runs through the palm of the hand between the muscles of the ball of the thumb and the muscles of the little finger.

What is a carpal tunnel syndrome?

This is a condition involving “nerve entrapment” in the hand. At the apex of the hand, there is a broad ligament that runs between the muscles of the thumb and the little finger. This ligament (known as the Retinaculum flexorum) forms the roof of the carpal tunnel, which contains the metacarpal nerves (median nerve) and the flexor tendons of the fingers. In carpal tunnel syndrome, this channel becomes too narrow and causes pressure on the median nerves.

R. flexorum (carpal roof)

 

What are the symptoms of a carpal tunnel syndrome?

Typical symptoms of CTS include pain at night, sensory disturbance and loss of power in the hand and fingers. If the condition persists for several years, the muscles in the base of the thumb can waste away.

How does a carpal tunnel syndrome develop?

  • Excessive strain on the hand, for example as a result of regular computer use (typewriter) with an un-ergonomic keyboard, or frequent cycling
  • early wrist fractures
  • hormonal changes, such as pregnancy or thyroid disease.

How is CTS treated?

  • Avoiding excessive strain of the hand joints
  • ergonomic design of the workstation (e.g. keyboard platform)
  • treatment with night splints (which put the wrist joint in a neutral position at night in order to avoid excessively flexing/extending the wrist)
  • drugs or physiotherapy to reduce the swelling.
  • In many cases, however, surgery is required.

What happens during the procedure?

Instruments for endoscopic carpal tunnel release

Endoscopic release of the carpal tunne

During the procedure, the nerve channel is widened. This can be done both endoscopically and as open surgery. With endoscopic carpal tunnel release, a 2 cm-long incision is made in the area of the flexor surface of the wrist. A small probe containing a small scalpel is inserted through this incision into the carpal tunnel, between the median nerve and the carpal roof. Once the probe is located in the carpal tunnel, the carpal roof is released from within and the volume of the tunnel is therefore increased.

Sometimes, however, it is not possible to carry out this operation endoscopically. The carpal tunnel can become so distorted that it is impossible to even penetrate it with the probe, or the camera is unable to visualise what’s going on. With open carpal tunnel release, an approximately 3-5 cm-long incision is made in the palm of the hand, between the thenar eminence and the ball of the little finger. The carpal roof is then released from above. This procedure can be carried out both as an outpatient (clinic) and as an inpatient (hospital).

What anaesthesia is required for the procedure?

The anaesthetist will decide on the nature of the anaesthetic to be used in a one-on-one consultation with you. General anaesthesia, numbing of the entire arm and in individual cases for at-risk patients, even local anaesthesia are possible.

What risks does the surgery carry?

The operation’s success rate is extremely high, with its complication rate being at 2%. Your clinician will discuss the problems with you in a personal consultation.

What form does the follow-up take?

Immediately after the procedure, a dressing will be applied. This dressing should be changed at regular intervals by trained professionals. While the wound is still healing, the patient should avoid contact with dirt and water, since these could lead to an infection. After around 12-14 days, the sutures are removed.
During the first few weeks after the surgery, the hand should be protected. After this, the patient will attend the neurologist and the hand surgeon for a check-up.

Can I expect my symptoms to completely resolve?

In around 90% of cases, the symptoms resolve completely or considerably. If the nerves have been under pressure for some considerable time, some of the symptoms may remain. This is also why we do not recommend leaving it too long before having the surgery.