Carpal tunnel syndrome (CTS) is a pathology of the hand caused by a compression of the median nerve at the ventral side of the wrist. Carpal tunnel syndrome is manifested by tingling (paresthesia), tingling, or even pain in the hand and fingers.
Carpal tunnel syndrome can be treated by a hand surgical procedure that consists of a section of the carpal tunnel anterior ligament (LAAC) covering the tunnel carpal tunnel. The post-operative effects of a surgical treatment of carpal tunnel syndrome are usually simple and not painful.
What is the Carpal tunnel syndrome?
Carpal tunnel syndrome (or CTS) is the transition zone between the forearm and the hand. Located at the level of the ventral side of the wrist, the carpal tunnel is an inextensible osteofibrous tunnel in which engages the median nerve (which ensures the sensitivity of the fingers as well as the motricity of certain tendons allowing the hand and fingers to sag).
Carpal tunnel syndrome is a pathology of the hand caused by compression of the median nerve by the anterior carpal ligament (LAAC) or, more rarely, by synovitis (inflammation of the capsule membrane of the joint) or a compressive tumor (lipoma, angioma).
What are the causes of the Carpal tunnel syndrome?
Carpal tunnel syndrome is an idiopathic pathology (without obvious cause) even if there are predisposing sites: diabetes, pregnancy, wrist fracture, chronic renal failure, inflammatory diseases, occupational exposure (repetitive hand and wrist activity, bad position of the hand, prolonged flexion of the fingers).
The first manifestations of a carpal tunnel syndrome are characterized by tingling (paresthesia) of the hand and fingers (thumb, index, middle finger, part of the ring finger). Sensations of tingling, burning or electric shock may be felt, especially during the night and when waking up.
Pain can then appear in the hand. These can go back to the forearm, the elbow and, more rarely, the shoulder.
Why treat this pathology?
If the compression of the median nerve is not treated, a loss of sensitivity in the fingers, a decrease in the strength of the hand and a melting of the muscles will appear gradually. Carpal tunnel syndrome involves sensory and motor problems such as a lack of mobility of the thumb, a clumsiness or a loss of sensitivity of the hand.
An electromyogram is usually performed to confirm the diagnosis. This is a technique consisting of measuring the speed of circulation of nerve impulses. This examination makes it possible to define if the nerve damage is important as well as the adequate treatment (infiltration and wearing of a sling or surgical intervention).
Surgical treatment of carpal tunnel syndrome
Carpal tunnel syndrome can be surgically treated with a decompression of the median nerve. The procedure consists in performing a section of the anterior carpal ligament covering the carpal tunnel tunnel.
The surgical procedure : decompression of the median nerve
The procedure can be performed endoscopically (leaving one or two small scars) or open (leaving a larger scar in the palm of the hand).
Dr. Kron uses an open-air technique known as "mini-open" that allows for a mini-incision in the palm and offers the advantage of direct control of the nerve and the importance of compression.
Decompression of the carpal tunnel can not be performed endoscopically when the wrist is particularly stiff and in case of significant synovitis.
Hospitalization during carpal tunnel surgery
The surgery is usually performed on an outpatient basis under local anesthesia (only the upper limb is anesthetized).
Recovery after a correction of carpal tunnel syndrome
The post-operative effects following a surgical decompression of the median nerve are simple in the vast majority of cases.
When do the symptoms disappear?
The disappearance of the symptoms and the functional recovery depend on the precocity of the intervention. In the case of simple compressions, quickly diagnosed and treated, sensory disorders and pain disappear quickly (within a few days). In cases of severe compression, the disappearance of paresthesia is slower and recovery may take several months. In the case of old or very large compressions, recovery may not be complete.
Recovery is usually achieved within one week. During this period, the wearing of dressings is necessary. Dr. Kron sets up wires that are self-resorbing and do not need to be removed.
Is there a need for rehabilitation?
Rehabilitation of the hand and wrist is usually not necessary. In some cases physiotherapy sessions may be indicated to accelerate recovery (especially when postoperative inflammation is important).
Cases of recurrence of carpal tunnel syndrome are exceptional. If another compression zone is discovered further upstream (ulnar nerve at the elbow, for example), a second intervention may be considered.
Smoking increases the risk of surgical complications of any surgery. Stopping smoking 6-8 weeks before the procedure eliminates this additional risk. If you smoke, talk to your doctor, surgeon, and anesthesiologist, or call Tobacco-Info-Service at 3989 to help reduce risk and put the odds on your side.
Risks of complications: Algodystrophy
Although the risks of complications are rare. Nevertheless it must be considered that decompression of the median nerve is a surgical procedure that involves the risks associated with anesthesia and surgery (see Risks in Surgery).
What is Algodystrophy?
Algodystrophy is a non-exceptional complication, even common in certain pathologies such as wrist fractures (about 20% of cases regardless of the treatment used). It is a kind of inflammation triggered by sometimes minimal trauma or even minor surgery. Symptoms: swollen, painful hand, with perspiration, then stiffness. The evolution is dragging several months, several years, sequelae are possible (residual pain, some stiffness of the fingers and / or wrist, sometimes even the shoulder).
It is currently impossible to predict what kind of patient will make such a complication.
What are the signs of algodystrophy?
The signs of this affection are marked by often important pains (apparently disproportionate), articular stiffness, swelling of the hand and fingers, sensations of hot and / or cold, a diminution of force.
Sometimes these signs are limited to part of the hand, sometimes the shoulder can also be reached. Examinations are rarely necessary to confirm the diagnosis. In particular, we can observe a localized decalcification of the bones of the hand on radiographs. Its diagnosis once stated the treatments vary according to the pains and the inconvenience in the movements.
The treatment makes it possible gradually to reduce the clinical signs but the evolution remains capricious during several months, even one or two years.
End-term sequelae can not always be avoided despite well-conducted treatment.