Carpal tunnel syndrome is probably one of the most frequent pathologies in hand surgery and its treatment has become more and more frequent in the last years.
This pathology is due to the compression of the median nerve within the carpal tunnel, an osteo-fibrous structure that contains also nine flexor tendons.
Classically, the median nerve gives sensitive innervation to the first three digits and to the radial half of the fourth one, and motor innervation to the intrinsic muscles of the thumb, although individual variations are not rare.
The course of the median nerve within the carpal tunnel is also variable.
The triggering event is represented by an increase of pressure within the carpal tunnel itself; this can be caused by many pathologies, among which diabetes, hypothyroidism, rheumatoid arthritis, systemic pathologies, hormonal pathologies, pregnancy, traumas, or work-related.
Other rare causes are possible, as tumors, infections, anatomical anomalies.
Nethertheless, a precise cause cannot be found in the majority of cases, so the carpal tunnel syndrome is defined idiopathic.
CTS is often associated with trigger digits and De Quervain's disease.
The increasing pressure within the carpal tunnel produces neuronal disorders, which can be resumed as follows:
. pain, numbness and tingling, that can disturb the normal sleep and can sometimes be resolvedby changing the limb position, or immersing the hand in warm or cold water, or even massaging the hand.
Numbness and tingling can be present also during the daytime, especially while sewing, driving, or having long telephone calls.
. pain, that can reach the shoulder
. loss of strength, objects fall from the hands
Diagnosis in based on clinical history and evidence, positivity of special maneuvers and of EMG.
CTS treatment can be conservative, or surgical.
Conservative treatment consists in:
. FANS therapy
. steroid inoculation
. wrist splinting
The conservative treatment is usually reserved to initial cases (less than one year); it is often possible to reduce the symptoms, sometimes even eliminate them, but the duration cannot be foreseen.
The surgical treatment can be open, or endoscopic; the aim of the operation is to divide tre transverse carpal ligament, in order to reduce the pressure within the carpal tunnel.
The operation can be performed with local anaesthesia, and takes about ten minutes.
Return to work is faster with the endoscopic technique, although a comparison of the results at six months showed similar results with both techniques.
Complications can be classified into three major groups:
1. Persistent symptoms, due to incomplete section of the transverse carpal ligament
2. Relapse of sympoms, which present again after some weeks, caused by fibrous proliferation of the scar, or by tenosynovitis of the flexor tendons, that may require reintervention.
3. Appearance of new symptoms, such as scar related pathologies, or pain related to the section of very small sensitive nerves, or pillar pain.
Dottor Giovanni Brunelli
Specialista in Chirurgia
Plastica Ricostruttiva ed Estetica
Via Guido Zadei, 64
Orari d'apertura: su appuntamento.
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