Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is one of the compressive syndromes of the hand, in which the median nerve is damaged by pressure inside the wrist canal. It is the most common type of compressive neuropathy.

• The exact cause of nerve compression is unknown, only the risk areas where nerve compression occurs have been described.
• There are several places on the upper limb where nerves can be compressed - they are called according to the place where the nerve is compressed, or according to the authors who described them: (Cubital Tunnel Syndrome, pronator teres syndrome, Guyon's tunnel syndrome, Wartenberg's syndrome and others).

Symptoms of nerve compression in CTS:

• Numbness in the fingers - thumb, index finger, middle finger, half of the ring finger  
• Tingling sensations  
• Pain in the hand (feeling, that the hand is on fire) 
• Pain comes at any time, patients often wake up to it at night and it helps to "shake" the hand.  
• If the nerve compression is long-term, motor fibers are also damaged and the fingers, especially the muscles forming the thumb shaft, become weak. In a more advanced stage of the disease, it happens that objects fall out of the hands (opposition of the thumb when grasping).

The first important sign for diagnosis is the patient's clinical complaints. Clinically, a sensation of "electricity" can be elicited when a nerve in the wrist is tapped (Hoffman-Tinnell's sign).

A neurologist who examines the speed of nerve conduction using electromyelography (EMG) will help with the diagnosis. EMG is an objective examination that will also determine the extent of nerve damage.

Patients with carpal tunnel syndrome have a choice of conservative methods - especially the use of splints and treatment with group B vitamins. The application of corticoids is not recommended.

• The operation is aimed at releasing of the pressure by cutting the ligament that is located in the palm and closes the carpal tunnel. By cutting the ligament, the entire tunnel is opened and the nerve has more space - it is no more compressed.
• The operation is performed under local anesthesia and a pressure cuff (tourniquet) is placed on the arm to ensure a bloodless operating field - similar to when blood pressure is measured in an ambulance.
• The tourniquet can be inflated for up to 60 minutes. However, about 30 minutes is enough for the operation itself.
• The wound is closed with stitches, which must be removed after 14 days. If the site was bleeding a lot, a small capillary drain is inserted, which is removed on the 2nd postoperative day.

Surgery using a laparoscope has no advantage over a conventional incision.

Postoperatively, the hand is bandaged, and during check-ups it is only necessary to cover it with plasters.

• The hand can be used for normal daily activities.
• The dressing must remain clean and dry.

The first positive sign after surgery is relief from night pains.

Sometimes, however, is the nerve damaged too much and even surgery does not bring relief. Any reoperation is carried out no earlier than after 3 months and it is advisable to repeat the electromyography (EMG).