Treatment of carpal tunnel syndrome

Treatment of carpal tunnel syndrome


Carpal tunnel syndrome is a common disease that causes pain, stiffness and stinging in the palm hand. The condition occurs when one of the main nerves in the palm hand – the so-called medianus, is squeezed or compressed on its way through the wrist.
The carpal tunnel is a narrow canal in the wrist. The bottom and sides of the canal are formed by the small bones of the wrist called carpal bones, while its roof consists of a solid band of connective tissue called the transverse ligament. Through the channel the flexor tendons of the palm hand and the medianus pass through it, which is very rigid. The neot medianus is responsible for the sensitivity of the thumb, index finger, third and half of the fourth finger, as well as the motor base of the thumb.

In carpal tunnel syndrome, the nerve medianus experiences pressure that causes pain, tingling and weakness of the palm hand to the extent that the patient is likely to start releasing objects from his/her hand. Over time, hip muscle hypertrophy develops around the base of the thumb (the so-called tenor muscle). Risk factors include heredity, repetitive hand and wrist flexion, hand overload, pregnancy, some systemic diseases such as diabetes, rheumatoid arthritis and thyroid imbalance. Symptoms of carpal tunnel syndrome increase over time and can lead to nerve damage.

Carpal tunnel syndrome is diagnosed by physical examination of the patient with various specific examination tests, and diagnostic procedures such as ultrasound, EMG (electromyography), X-ray and magnetic resonance imaging are further used.

Treatment of carpal tunnel syndrome initially involves immobilizing the wrist by wearing various orthoses that prevent wrist movements and taking anti-inflammatory NSAIDs, as well as changing daily and professional activities that trigger daily and professional activity the nerve in the carpal tunnel. Physical therapy procedures are also used. Carpal tunnel syndrome is also treated with topical administration of anti-inflammatory corticosteroid injections, but most often their effect is not long-term.

If conservative treatment fails to alleviate the symptoms of carpal tunnel syndrome, surgical treatment is initiated. Surgical treatment belongs to the one-day surgery group and is usually performed under local anesthesia by placing a cuff on the arm to work in a bloodless field. A small incision is made on the inside of the wrist (palm root) and the transverse ligament covering the carpal tunnel is visualized. The transverse ligament is then cut, extending to the carpal tunnel and median nerve decompression. The surgical incision is then sutured and a compressive wrap is made on the arm. After 10 to 15 days, the stitches are removed from the wound. The transverse ligament will heal over time but will have more space in the carpal tunnel and the nerve will not suffer. In the postoperative period, it takes several weeks to months for the complete function and movements of the hand and wrist to return.