Carpal tunnel syndrome (CTS)

Carpal tunnel syndrome is a condition in which the median nerve (mid-arm nerve) becomes trapped at the wrist. The condition more commonly affects women.

Symptoms

Often, patients complain most of pain in the wrist area with a tingling feeling, often with radiation into the thumbs, index finger and in some cases the middle finger. Radiation to the lower arm is not uncommon either. Often, however, both hands can be affected. In the later stages of the condition, it is not uncommon for muscle weakness and atrophy to develop.

At first, the symptoms are worse at night. The symptoms of carpal tunnel syndrome are often similar to those of intervertebral disc prolapses and other conditions affecting the lower cervical spine. This is why examination of the cervical spine with an MRI scan is recommended. Electrophysiological investigations (electromyogram EMG, nerve conduction studies NCS, etc.) can confirm the diagnosis.

Causes

Thickening of the palmar ligament (Retinaculum flexorum) or tendons in this area, leading to narrowing in the "tunnel". The ligament can become thickened as a result of tendon inflammation or tissue swelling secondary to constant excessive mechanical strain. The following situations could lead to this: congenital narrowing of the carpal tunnel, excessive physical strain, pregnancy, diabetes, injuries, kidney disease and others.

Treatment

For mild symptoms, conservative therapy such as physiotherapy, massages, the wearing of hand splints, acupuncture, electric current therapy, the taking of painkillers and injections in the affected area may be sufficient. If these fail to produce any pain relief, or if the symptoms are already unbearable or there is a neurological deficit, then surgical treatment is recommended.

During the procedure for carpal tunnel syndrome, more space is created for the nerve by dividing the ligament in the palm of the hand (Retinaculum flexorum). The procedure can be carried out via a small incision in the wrist or endoscopically under local anaesthetics, plexus anaesthesia or general anaesthetics, and either as an outpatient or in-patient.

Results

The symptoms of pain are greatly alleviated following relief of the nerves or widening of the "tunnel". Rarely, residual problems are left behind such as if the nerve was compressed for a long period, or if the underlying condition, e.g. diabetes, has not been treated adequately. In some cases, scarring occurs that can once again cause symptoms. In these instances, the procedure can be repeated.

Follow-on treatment: The sutures are generally removed 10 days after the procedure. To begin with, patients wear a bandage or splint. Time off work, sometimes of a few weeks, is appropriate, depending on the patient's profession.