Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common disease. It is the oppression of the medial (middle nerve) by a tight, overgrown carpal ligament as it passes through the carpal tunnel at the entrance to the palm of the hand.
It is typically manifested by pain and tingling/tingling in the palm of the hand and especially the fingers. The change in sensitivity is often described by patients as a feeling of dullness, swelling and stiffness of the fingers. Difficulties may be resting, typically occurring at night and waking the patient from sleep. In daytime activities, sufferers report an increase in difficulty, for example, during manual activities, cycling, driving a car or pushing a pram, when there is increased pressure on the nerve from outside. Other complaints in more advanced stages of the disease include impaired fine motor skills of the fingers, weakening of grip, sometimes with objects falling out of the hand.
Carpal tunnel syndrome can be treated conservatively in milder forms (physical sparing, wrist bracing, carpal tunnel spraying), but this treatment is often not very effective and it is necessary to resort to surgery. This is indicated even without prior conservative treatment in more severe forms of the disease. Carpal tunnel surgery is the most common surgical procedure in hand surgery. It is usually performed classically, open. In this type of surgery, not only the solid carpal ligament, but also all more superficial structures (palmar aponeurosis, subcutaneous tissue, skin) must be cut, creating a scar in the area of the transition from the wrist to the palm, which is stressed during normal hand activities, This often causes persistent local pain in the area of the scar, which may also radiate to the fingers or forearm (pillar pain), or may persist for a longer period of time with impaired grip and hand pressure (opening a PET bottle, gripping a door handle, cutting with a knife, etc. )
As you can understand, everything in medicine and surgery in particular can bring its own negatives and complications. In endoscopic surgery for carpal tunnel syndrome, we rarely encounter postoperative subcutaneous hematoma (blood spurt, bruise or bruising if you prefer). Of course, inflammation in the surgical field or mechanical damage to the median nerve being released cannot be completely excluded.
The use of endoscopic surgery is wide in the diagnosis of carpal tunnel syndrome, however, it is not recommended in patients after fractures with subsequent significant deformity of the wrist area. Endoscopic surgery has also not been performed in the past after previous unsuccessful conventional carpal tunnel surgery.
However, it is not only our experience that minimally invasive endoscopic surgery can now be offered to patients with recurrent (recurrence after transient improvement) carpal tunnel syndrome. However, it is necessary to mention this case when making an appointment for the procedure and to consult with Dr. Šoula.
In the event that endoscopic surgery cannot be performed, we will offer you surgery using the classic open technique. Exceptionally, a situation may arise during an endoscopic operation which for some reason (e.g. insufficient visibility of the operating field, completely unfavourable anatomical conditions) does not allow the procedure to be performed completely using the minimally invasive technique and it is necessary to complete it using the classical surgical technique in order to maintain safety and reliability for the patient.
In the endoscopic surgical technique, a short skin incision (10-15mm) in the wrist crease is sufficient and with the help of special instrumentation we selectively cut only the carpal ligament while sparing all other superficial structures of the hand. The scar area is not in a stressed area and therefore heals better and in the vast majority of cases does not cause any discomfort to the patient. As a result, the minimally invasive endoscopic approach results in faster recovery and return to normal activities, work and hobbies.
Patient's appointment
The diagnosis of carpal tunnel syndrome must be confirmed preoperatively by the findings of an EMG (electromyographic) examination, which you will need to book an appointment for surgery, either by e-mail: info@neuroendo.cz or by phone: 739 029 195.
If you have an evident clinical suspicion of carpal tunnel syndrome and you still do not have an EMG, we will help you to obtain one.
We operate every month. The next surgery dates can be found HERE
Surgery procedure
so that nothing hurts. In the meantime, we will prepare everything necessary for your surgery.
Once you are comfortable in the operating room, we will place a tourniquet on your arm, hand and part of your forearm
…and carefully sanitize and debride the forearm. We then inflate the tourniquet to achieve a bloodless surgical field. Through a short skin incision in the wrist area and subsequent preparation, we enter the carpal tunnel and slightly widen it with special instruments. We insert an endoscopic knife with integrated optics and cut the carpal ligament under visual inspection. Before removing the endoscope
we check for complete release of the median nerve and finish the operation by suturing the wound with a skin suture.
The actual surgery takes about 10 min, with the necessary preparations, time to get the local anaesthetic on perfectly you will spend a total of 45-60 min with us.
Before we say goodbye, we will instruct you on the early and longer term post-operative regimen. Don’t worry, everything you need to know will be given to you in hard copy, just in case you happen to run into any problems along the way.
on the way home.
After the operation
You can expect the pain to disappear or be significantly relieved in the first 2 days after surgery, and the tingling/tingling of the fingers to subside quickly, but you will usually have to wait much longer (weeks to months) for the sensitivity of the fingers and palm to improve, as well as for the muscle strength and dexterity of the affected hand to improve. In some patients with very severe pre-operative hand disability, the nerve may already be irreversibly affected and functional improvement unfortunately no longer occurs, but pain is reliably improved by nerve release.
You can gently engage the hand in activities after a few days, but avoid putting pressure on the wrist-palm junction area (gripping objects, opening doors by pressing the handle, etc.).
In the event of post-operative pain in the wound or palm area, do not avoid the use of commonly available analgesics.
Immediately after surgery
Patients leave with a sterile wound cover and an elastic wrist bandage, which can be removed the evening of the operation. Afterwards, the wound is only covered sterilely. It is important to maintain the sterility of the wound in the first postoperative days and therefore we do not recommend exposing the wound in the first 2-3 days. In case of tearing, significant soiling, soaking of the covering, its sterile replacement is necessary if possible.
The hand can be gradually involved in light activities from the next day of surgery, initially very carefully. A raised position of the operated limb and occasional movement of the fingers in the ‘upright position’ are very helpful. If your hand hurts, take a common analgesic (Ibalgin, Aulin, Paralen, etc.).
Preferably take the anti-swelling drug Aescin at a dosage of 2-2-2 for 10 days, it is freely available over the counter at the pharmacy.
After removal of stitches
Approximately on the 10th postoperative day, we remove the stitches and cover the healed wound with a small covering, which can be removed definitively the next day.
Gradually you can use your hand more and more in normal activities, the time interval from surgery to full use of the operated hand is individual and varies between 2 – 6 weeks.
Most of our patients do not need special rehabilitation and it is completely sufficient to perform pressure massage of the wrist-palm transition with the other, non-operated hand. Preferably, the exercise involves repeated squeezing of a softer massage ball.
Don’t worry, we will instruct you on all the essentials during surgery and post-operative check-ups.
Back to work and hobbies
Make an appointment for a procedure or consultation. We will be happy to explain everything if you have any questions.