The doctor. Rodrigo is a specialist in Traumatology in Valencia, as well as an orthopedic surgeon. This article explains what carpal tunnel syndrome is and how it is treated.
The carpal tunnel is a canal formed in the palm of the wrist by the carpal bones where the intrinsic muscles are inserted and is covered by a fibrous band which is the annular ligament. Through this canal the median nerve, responsible for the sensitivity of the first three fingers, and the opposing force of the thumb to form the "digital clamp," take place, and in addition all the tendons help to flex the wrist and the fingers.
Carpal tunnel syndrome
Carpal tunnel syndrome is a relatively common pathology. Although it is more common in women between 30 and 60 years of age, this problem can affect anyone who uses their hands in certain positions in a repetitive way, usually in a forced position of flexion, such as secretaries, workers in textile manufacturing, force, in workers who use vibrating machines, but also in other cases as pregnant (during the last trimester), or secondary to any process that alters the normal anatomy of the wrist (fracture sequelae), leading to an increase of the pressure on the median nerve, which is the weakest structure, say "complaining", giving rise to a very characteristic clinic, tingling and pain in the second and third fingers, associated with numbness and loss of strength of the hand, and that increases its intensity at night.
The prolongation of nerve compression over time will also lead to atrophy of the tenar musculature (the part of the palm depending on the thumb).
Diagnosis of Carpal Tunnel Syndrome
The diagnosis is simple with simple exploratory maneuvers, consisting of stimulating by a gentle percussion on the palm of the wrist the nerve, reproducing a sensation of cramp (tinel test), or through hyperflexion of the wrist (phalen test) .
Normally, in order to corroborate the diagnosis, the patient will be asked for complementary tests, such as electromyography (EMG), which consists of nerve stimulation in order to assess its response, and from this the degree of involvement and the anatomic level where the compression is found, since although we may rarely find similar nervous alterations at the level of the elbow or neck.
Treatment of Carpal Tunnel Syndrome
The treatment of this pathology, whenever slight, can be medical and functional, using orthesis (wristbands) to avoid hyperflexion, anti-inflammatory and even infiltration with corticosteroids, which help to reduce the inflammation of the interior of the carpal tunnel locally.
When the conservative treatment does not work or the compression has reached a level of severity in the EMG, the patient will be advised to undergo a surgical treatment, which will consist of tuning the tunnel, opening the annular ligament, and reviewing other possible conditions that may exert a compression on the nerve.
Two different surgical techniques can be performed:
1. Open surgery of the carpal tunnel is performed by a mini-incision in the palm of the wrist through which the ligament can open and explore the nerve.
Usually, this surgical technique can be performed under local anesthesia, after which a bandage is maintained for two weeks until the removal of stitches (normally at 15 days), and a gradual improvement of the clinic, although the loss of strength may last for two or three months, and this is due to the opening of the annular ligament.
2. The other surgical possibility is the realization of an opening of the annular ligament endoscopically, using a mini incision of 1cm in the crease of the wrist, through which a vision cannula is inserted that allows to see the nerve, to explore it and to control the section of the ligament.
The operation requires loco-regional anesthesia, (sleeping the entire arm), since it may be somewhat longer in time. This technique minimizes aesthetic effects and postoperative time, with less temporary loss of strength.