What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is one of the most common nerve compression syndromes affecting the hand.
This condition involves compression of the median nerve within the carpal tunnel, which is formed by the carpal bones on the back of the hand and by a sheet of connective tissue (known as the flexor retinaculum) on the palm side. In addition to blood vessels and nerves, the flexor tendons of the fingers also run through this canal.
If the nerve is compressed within this canal—which is most commonly caused by thickening of this connective tissue plate, but also by inflammation of the flexor tendon sheaths (e.g., in rheumatological conditions) or as a result of a radius fracture, etc., you will notice a recurring “tingling” sensation in your fingers, especially in the thumb, index, and middle fingers.
This initially occurs mainly at night, as the wrist is often held in a flexed position during this time, which triggers the symptoms. In addition, there is pain and weakness in the hand; objects may suddenly “slip out of the hand,” and the muscles at the base of the thumb atrophy.
If you are experiencing these symptoms, it is essential to undergo an evaluation by a neurologist, including a measurement of motor and sensory nerve conduction velocities.
If you have previously had a radius fracture, an X-ray of the wrist—a “carpal tunnel target view”—should also be taken to rule out bony protrusions into the carpal tunnel.
Information on the operation
You should not have any open wounds or scratches on the hand in question before the operation, as this increases the risk of infection. If the skin is very rough and hard, the hand should be treated with a well-lubricating hand cream several days before the operation and, if necessary, a disinfectant hand bath should be carried out the evening before the operation.
In carpal tunnel syndrome surgery, the constricting connective tissue band over the carpal tunnel is cut, thereby relieving pressure on the nerve. The surgery is performed under what is known as “bloodless field,” meaning that a blood pressure cuff is placed on your arm and inflated to allow for surgery with minimal bleeding and a clear view. The skin incision is usually made along a pre-existing skin fold on the palm side of the hand. After incising the skin and fatty tissue, the thickened “retinaculum flexorum” is cut, thereby “releasing” the nerve. The skin is then sutured, and a compression bandage is applied.
For mild symptoms before Following the surgery and a slight increase in nerve conduction velocity, an initial attempt can be made to improve symptoms by wearing a wrist splint at night (which keeps the wrist in extension). If this does not result in any improvement, or if—despite normal nerve conduction velocities—the description of the symptoms and the clear clinical findings point to carpal tunnel syndrome, surgery is indicated.
If the condition has been present for a long time, irreversible compression damage to the nerve may have already occurred, meaning that sensation in the fingers, hand strength, and pain may not fully recover after surgery.
Procedures should be performed depending on the level of distress and the severity of the condition. We are, of course, here to advise you. We will work with you to determine the exact procedure and the optimal, individualized treatment plan for you during a detailed consultation.
Hospital stay and anesthesia
The surgery can be performed under local anesthesia of the hand, under local anesthesia of the brachial plexus, or under General anesthesia. A hospital stay is not required for carpal tunnel release.