INTRODUCTIONHere you'll find a general overview of the symptoms and causes of carpal tunnel syndrome, as well as how it can be treated. It's important to remember that when a condition is diagnosed, the situation can be different for everyone.WHAT IS CARPAL TUNNEL SYNDROME?Carpal tunnel syndrome occurs when a nerve (the median nerve) becomes compressed at the wrist. This nerve runs from the forearm to the palm through a tunnel formed by the carpal bones and a strong tendon sheath (the transverse ligament) on the palmar side of the wrist. The flexor tendons of the fingers also run through this tunnel. The nerve compression is caused by swelling of the connective tissue, which increases the pressure in the tunnel.COMPLAINTSThe symptoms of carpal tunnel syndrome are generally quite characteristic and are most common in women. They often consist of numbness and tingling on the inside of the hand, radiating to the first three or four fingers. These are precisely the fingers supplied by the pinched nerve. Sometimes patients report numbness in all fingers, including the little finger; sometimes there is also radiating pain from the inside of the hand, via the elbow region, to the upper arm and shoulder.
In addition to numbness and tingling, other symptoms may include a tingling and painful sensation in the fingers and hand, a swollen feeling, and a loss of strength in the hand, causing you to drop things.
Carpal tunnel syndrome often manifests spontaneously. Sometimes the symptoms worsen with frequent use of the affected hand, such as driving, cycling, reading, or wringing hands. Carpal
tunnel syndrome can sometimes occur in both hands (almost simultaneously, but often one after the other). If carpal tunnel syndrome has been present for a long time, loss of strength in the fingers can sometimes occur.
Nighttime symptoms are very common. Patients report waking up and having to make hand movements to relieve the symptoms. This also occurs upon waking in the morning.WHAT IS THE CAUSE?Carpal tunnel syndrome is caused by compression of the median nerve due to swelling of the surrounding tendons in the hand. This can result from frequent and repetitive hand movements. Pregnancy, obesity, and diabetes are also known risk factors for developing carpal tunnel syndrome. Symptoms can also occur during early menopause.IS FURTHER RESEARCH NEEDED?Based on the pattern of symptoms, the diagnosis can often be suspected. If symptoms increase or occur with local pressure on the nerve, the likelihood increases. To determine for sure whether carpal tunnel syndrome is present, a muscle nerve examination is necessary. This examination is called an EMG (Electro-Myography). It involves measuring the nerves of the hand with electrical impulses.TREATMENTFor mild symptoms, (temporarily) adjusting the activities of the affected hand can often be enough to resolve them. If only nighttime symptoms are the primary cause, a temporary night splint can be used. CTS symptoms that arise during pregnancy, and often resolve spontaneously after pregnancy, can often be effectively treated this way.
If you have been diagnosed with an underlying condition (such as diabetes), it should, of course, be treated as effectively as possible. Another option is an injection that reduces the local swelling of the tendons at the level of the carpal tunnel. This is a very patient-friendly treatment. Many patients will become symptom-free as a result.
If this treatment does not resolve the symptoms, the next step is surgery to cleave the tendon sheath to create more space for the nerve. You will be referred to a surgeon for this.THE OPERATIONThe surgery aims to relieve pressure on the nerve. This can be done in two ways:
- Traditional surgery.
- Keyhole surgery.
Classical surgery
.
This is a minor procedure in which an incision is made in the wrist on the palm side. The transverse ligament is cut. This widens the tunnel. The surgery takes about twenty minutes and is generally performed under regional anesthesia, leaving only the arm numb. The surgery is usually performed as an outpatient procedure. This means that you can return home once the anesthesia has worn off. You will then be given painkillers.
Keyhole surgery
. This is not yet widely performed in the Netherlands. It involves making two small incisions through which the surgery is performed using special instruments. The advantage of this is that the incisions are smaller, resulting in smaller scars. A disadvantage is that two percent of surgeries fail, and in subsequent two percent of cases, the syndrome returns over time.POSSIBLE COMPLICATIONSNo procedure is without the risk of complications. This procedure also carries the usual risks of complications. Fortunately, these are rare. Bleeding and sometimes wound infections are the most significant.AFTERTREATMENTThis is the same for both methods. It's wise to keep your arm in a sling for the first day(s). The pressure bandage applied after the surgery can be removed after one day. You can also start doing finger exercises soon. This will be a bit difficult at first, but it will become much easier after a few days. If your fingers become blue and cold, or if you experience significant pain on the day of the surgery or the day after, please contact the hospital's Emergency Department as soon as possible.WHAT ELSE YOU NEED TO KNOWThe scar on your wrist often remains sensitive for a longer period of time, especially when pressure is applied to the area, such as when supporting yourself. The discomfort you experienced beforehand often disappears immediately after the surgery. The stitches can be removed after seven to ten days. You should expect to have much less strength in your thumb for a long time. This is because the muscles of the ball of the thumb have become more or less detached on one side due to the cleavage of the transverse ligament. |
