Carpal tunnel syndrome

Carpal tunnel syndrome, or carpal tunnel

Carpal tunnel syndrome is the compression of a nerve, the median nerve, which passes through a rigid tunnel in the wrist. The median nerve gives sensitivity to part of the hand and moves certain thumb muscles. It passes through the carpal tunnel with the tendons responsible for finger flexion. As these thicken, they compress the median nerve.

Symptoms of carpal tunnel initially manifest themselves as tingling, burning or pain in the thumb, index and middle fingers at night or in the morning. They can then occur during the day, for example while driving a car, reading a newspaper, or using a tablet or smartphone.

Patients regularly report dropping objects. In more advanced cases, there may be a permanent loss of sensitivity in certain fingers.

What are the tests for carpal tunnel?

Diagnosis is essentially made during the consultation by the doctor’s examination. Two tests can help confirm the diagnosis of carpal tunnel : electroneuromyogram (ENMG) and ultrasound.

• ENMG:

This examination, performed by a neurologist, evaluates the function of the median nerve using electrical stimulation. It allows us to pinpoint the location of nerve compression and the severity of the damage. The examination takes around thirty minutes, and you’ll feel small electric shocks similar to those you feel when you touch an electrified fence. The examination is generally painless.

• Ultrasound:

The evaluation is carried out by a surgeon from the Clinique de la main in Geneva. This is a painless examination lasting around fifteen minutes, which assesses the appearance of the median nerve at the wrist and the appearance of the tendons at the wrist.

What treatments are available for carpal tunnel?

• Non-surgical carpal tunnel treatments :

When the disease is at an early stage, non-surgical treatment can be attempted. It involves immobilizing the wrist in a splint at night, and sometimes during certain manual activities, for two to three months.

Possibly, an infiltration of local anti-inflammatories (cortisone) directly into the carpal tunnel may be considered. This can sometimes bring relief from carpal tunnel symptoms, which are often transient.

• Surgical treatment of carpal tunnel :

When symptoms persist, surgery should be considered to relieve carpal tunnel symptoms. The aim is toopen up the “roof” of the carpal tunnel to make room for the median nerve.

The tingling usually disappears within a few days, unless the nerve compression was severe, in which case recovery takes longer and may last several weeks or months.

Carpal tunnel surgery at the Clinique de la Main in Geneva

At Geneva’s Clinique de la Main, carpal tunnel surgery is performed on an outpatient basis. Anesthesia can be local: only the palm of the hand, administered by the surgeon. It can also be performed locally: anaesthesia of the forearm and hand, by an anaesthetist.

Once the carpal tunneloperation is complete, you will be discharged with a padded dressing or plaster splint to avoid pressure on the palm of your hand.

It’s important to move your fingers as normally as possible.

Carpal tunnel surgery takes around two weeks to heal completely. This corresponds to the time required to remove the sutures, unless they are absorbable, in which case they will fall out spontaneously.

Carrying heavy loads and leaning on the palm of the hand should be avoided for four to six weeks.

While an office job allows you to return to work in as little as two weeks, a manual job requires you to take four to six weeks off work. Pain when pressing against the scar and a lack of clamping force often persist for two to three months.

What are the possible complications?

• Complications of non-surgical treatment :

In very rare cases, carpal tunnel infiltration may be complicated by local infection. There is also a risk of developing a whitish spot on the skin around the injection site.

• Complications common to all surgery:

Infection of the wound may occur, but is usually cured by local care and the prescription of antibiotics. Surgical drainage is rare.

Hematoma corresponds to an accumulation of blood under the skin. It’s not a problem if it’s small, but if it’s larger, surgical evacuation may be necessary.

Healing problems (delayed healing, thick scars) occur more frequently in patients who smoke.

Involuntary injury to an artery, nerve, ligament or tendon may occur in very rare cases. These structures can be repaired, but recovery will be prolonged and may be incomplete.

Chronic carpal tunnel syndrome is a disproportionate inflammatory reaction of the body following surgery. It causes pain, swelling and stiffness, requiring treatment that can last several months.

• Complications specific to carpal tunnel syndrome :

Incomplete release of the median nerve is rare. It causes symptoms to persist or even worsen, necessitating further surgery.

Injury to the median nerve, tendon or artery during the procedure may occur in very rare cases, and may result in loss of sensitivity or mobility, as well as pain. These structures can be repaired, but recovery will be prolonged and may be incomplete.

Recurrence of carpal tunnel is rare, and is more often seen in patients suffering from conditions such as diabetes or hypothyroidism. Further surgery is then indicated.