What is carpal tunnel syndrome (CTS)?
Carpal tunnel syndrome results from entrapment of the metacarpal nerve (median nerve) in the carpal canal (the carpal tunnel). The carpal tunnel is very narrow and is formed by the carpal bones on the back and a firm connective tissue band between the little finger and thumb mice on the palm side. Through the carpal tunnel run the flexor tendons to the fingers and the median nerve.
The nerve is very sensitive to pressure. Sometimes a lack of space develops in the carpal tunnel and the median nerve becomes pinched. Possible causes of this lack of space include: swelling of the mucous membrane of the tendons caused, for example, by rheumatism, hormonal changes during pregnancy or menopause, a thyroid gland that works too slowly, irritation of the tendons after heavy manual labor or after a wrist or carpal tunnel fracture. Carpal tunnel syndrome is more common in diabetes mellitus (diabetes). Women are affected more often than men.
What are the symptoms in carpal tunnel syndrome?
The median nerve or middle hand nerve provides sensation in the thumb, index finger, middle finger and half of the ring finger. The nerve also runs to some hand muscles. Trapping of the metacarpal nerve in the carpal tunnel can cause partial failure of the nerve. Usually tingling occurs in the palm of the hand and in the fingers supplied by the median nerve. Often the symptoms occur at night and it helps to "wave" the hands around. Sometimes the symptoms are worsened by sitting in the same position for a while, such as riding a bike, driving a car, talking on the phone. The tingling can radiate to the elbow and sometimes even the shoulder. Sometimes patients experience clumsiness/dropping things. Some patients also experience loss of strength, and in severe cases, a decrease in the muscle mass of the thumb muscle may occur.
Diagnosis
Based on the pattern of symptoms and physical examination, the diagnosis can be made. In case of doubt, a so-called EMG (electromyogram) can be made, in which the function of the median nerve is measured. This can secure the diagnosis and also gives an indication of the severity of carpal tunnel syndrome.
If a definitive diagnosis of CTS is made, then a treatment plan is developed depending on the cause, the duration and severity of the symptoms and the patient's overall condition.
Treatment:
Non-operative (conservative) treatment
If there are mild symptoms or if the symptoms are most likely transient (as in pregnancy) then nonoperative treatment may be suggested. Wearing a brace (splint) during the night that ensures the wrist is not flexed during sleep may reduce symptoms. Avoiding provocative activities and postures during the day may also reduce symptoms.
In some cases, an injection of corticosteroids may be considered. Often the treatment effect of this is temporary.
Surgical treatment
Operative treatment is often chosen. The surgery is done in day surgery. A local anesthetic is given in the surgical area in the palm of the hand. The band that runs over the carpal tunnel is cleaved, in order to give the nerve enough room again. Flex Clinics is part of MSB Flex Coöperatie U.A. The wound is sutured with stitches that can be removed after 10-14 days. After surgery you will have a pressure bandage for several days. Often the symptoms subside soon after surgery. If the symptoms were present for a long time before the operation, or if the nerve was severely pinched, recovery may take a little longer. During the consultation hour you will receive detailed information about postoperative treatment and recovery and you will be given an information brochure about the procedure.
