What is the carpal tunnel syndrome?
The carpal tunnel syndrome is one of the most common hand conditions, which mostly affects the female population. It is frequently caused by regular wrist overloading (e.g. excessive manual work) or monotonously repeated activities (e.g. computer work).
The carpal tunnel is located in an area where the finger flexor ligament connects the finger muscles to the bones. It is involved in the functionality of the first to fourth finger nerve connections and is responsible for the sensitivity of the fingers and fine motor activity of the hand. This important neural canal has a kind of ceiling in the form of a rigid ligament cord, which can thicken and press against the delicate neural structures inside the hand, thus causing discomfort or even preventing the use of the hand at a full extent.
The carpal tunnel syndrome is therefore characterized by the narrowing of a neural canal as a result of the thickening of a ligament cord (ceiling of the canal). The nerve of the hand is therefore under a constant pressure, which causes pain.
Carpal tunnel: Symptoms
The carpal tunnel syndrome is a frequent condition caused by pressing the median nerve in the wrist. How do I become aware of the carpal tunnel syndrome? These are the symptoms:
- Finger numbness: Finger numbness in the right or left hand, mainly in the thumb, index finger and middle finger areas is one of the most frequent symptoms. If often occurs at night or after a prolonged activity that requires repetitive movement of the wrist.
- Wrist pain: The patients often suffer from a wrist pain, which can shoot into the forearm or as far as the shoulder. This pain can limit various activities such as typing or lifting objects.
- Weakness and reduced motor activity: The carpal tunnel syndrome can reduce the ability to grip objects or perform fine motor activities such as holding a pen or moving small objects. It can also be accompanied by the sensation of "disobedient" fingers.
- Swelling and stiffness: In some cases, the patients describe a feeling of stiffness in the wrist or swelling in the wrist canal area.
These symptoms usually become worse during the night and can interrupt the sleep. To prevent a permanent damage to the nerves, you should see a specialist in time.
Carpal tunnel: Treatment
The carpal tunnel syndrome treatment depends on the severity of the symptoms. In the early stages, conservative methods may be effective, but in the more advanced stages, a surgery often becomes necessary.
Carpal tunnel - exercises
Wrist rehabilitation exercises can improve circulation and reduce pressure on the median nerve. These exercises focus on stretching and strengthening the wrist and hand, thus reducing the pain and numbness.
Carpal tunnel - home treatment
In the early stages, a change of the daily routines may be helpful. We recommend limiting repetitive wrist movements and using a carpal tunnel orthosis, which keeps the wrist in a neutral position during the sleep. However, you should always seek specialized assistance to avoid worsening the carpal tunnel condition.
Carpal tunnel orthosis
Wearing an orthosis, mainly during the night, may relieve the numbness and pain. It prevents overloading the wrist and helps relieve the neural canal.
Carpal tunnel medication
Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce inflammation and pain. In the most difficult cases, the patient can be given corticosteroid injections to reduce inflammation in the wrist tunnel.
Surgery
The surgery is very effective and immediately eliminates the symptoms.
How is the carpal tunnel syndrome diagnosed?
The carpal tunnel syndrome diagnose is based on a physical examination and special tests such as electromyography (EMG), which measures electrical activity of the hand nerves and muscles.
Carpal tunnel surgery
If conservative treatment brings no relief and the symptoms prevail or deteriorate, a surgery becomes necessary. Carpal tunnel surgery is the most effective way of permanent elimination of the carpal tunnel syndrome.
It is performed under local anaesthesia and is considered a short outpatient procedure. After the local hand anaesthesia, the surgeon makes a small incision in the wrist area, thus disconnecting the thickened ligament that presses on the median nerve. This process will relieve the pressure on the nerve and allow its free motion in the wrist tunnel.
There are also less invasive methods where the surgery is performed by smaller incisions or by means of an endoscope, which reduces the risk of complications and accelerates the healing process.
Carpal tunnel postoperative recovery
The postoperative recovery depends on the pre-operative condition and the patient's healing ability.
- Carpal tunnel – postoperative exercises: It is important to start with gentle exercises immediately after the surgery to improve moveability of the wrist and fingers. The rehabilitation exercises help restore the strength and coordination of the hands and prevent the development of scar tissue.
- Carpal tunnel - rehabilitation: The surgery should be followed by physiotherapy, which includes exercises to strengthen and stretch the wrist. It takes several weeks and the duration depends on individual speed of the healing process.
- Return to normal activities: Most of the patients can go back to their normal activities within 4-6 weeks, but a longer period for complete recovery may be necessary in case of more demanding manual activities.
- Postoperative pain: The carpal tunnel postoperative pain is usually mild and can be tranquillized by prescribed analgesics (painkillers). It is the greatest during the first days after surgery, but it gradually recedes. Some patients may experience mild swelling in the surgical area. To relieve pain, we recommend keeping the hand in a raised position, above the heart level.
- Postoperative stitches: The stitches are usually removed after 10 to 14 days. During this period, the patient should follow the doctor's recommendations regarding hygiene and wound care. The wound should be kept dry and clean in order to prevent infection. In case of minimally invasive methods, the incisions may be smaller, which can accelerate the healing process.
- Postoperative limitations: Immediately after the surgery, we recommend limiting the hand use and avoiding any activities that might overload the wrist such as lifting heavy objects or performing repetitive movements. The patient should gradually start with gentle movements of the fingers and writs, following the doctor and physiotherapist's recommendations. Full restoration of normal activities may take 4 to 6 weeks, but patients performing manual work may require a longer period for full recovery.
Complications
In most cases, the carpal tunnel surgery is a safe and effective procedure, but as any surgery, it can be accompanied by complications. There are certain contraindications that can affect the treatment.
The potential complications include infection in the incision area. Although it is a minor surgery, it can be accompanied by reddening, swelling or pain in the wound area. In this case, you need to start an antibiotic treatment. Another potential complication is bleeding or haematoma in the surgical area, which can result in successive swelling and pain.
The surgery can also cause damage to the nerve endings or blood vessels in the wrist area. An injury may lead to a temporary (or rarely permanent) loss of sensitivity, tingling or weakness in the hand. In some cases, the surgery may be followed by a lasting pain or stiffness, which may require additional physiotherapy or treatment.
Another complication is recurrence, i.e. return of the carpal tunnel syndrome symptoms. This can occur if the pressure on the nerve has not been completely removed or if a scar tissue develops and again presses on the median nerve.
Contraindications
As regards contraindications, the carpal tunnel surgery is not suitable for every patient. People who suffer from acute wrist infection must wait for complete cure of the infection before the surgery. Another contraindication involves blood clotting disorders or long-lasting anticoagulant medication. These patients face an increased risk of complications during or after the surgery, so they should consult the doctor and potentially change the treatment prior to the surgery. Patients with uncontrolled diabetes may suffer from impaired wound healing, which prolongs recovery and increases the risk of infection.
Before the surgery, the patient must undergo thorough preoperative examinations and consult the doctor who will assess the patient's overall health and determine whether the carpal tunnel surgery is suitable.
Carpal tunnel surgery price
The price of the carpal tunnel surgery depends on the type of the treatment (classic surgery vs. minimally invasive treatment) and the applied methods. The price includes a consultation, surgery, anaesthesia and postoperative care including rehabilitation.
Frequently asked questions
What is a carpal tunnel?
- Carpal tunnel is a narrow passage in the writs through which the tendons and median nerve run. In the case of carpal tunnel syndrome, this nerve is squeezed, which causes pain, numbness and reduced moveability of the fingers.
What are the symptoms of carpal tunnel syndrome?
- The symptoms include finger numbness, writs pain, hand weakness and limited ability to grasp objects. They often worsen during the night or after repetitive wrist movements.
How long is the sickness period after the surgery?
- The carpal tunnel postoperative sickness period depends on the severity of the condition and type of the performed activities. On average, the patients return to the normal activities within 4 to 6 weeks.
