Described in 1950 by Palen, the carpal tunnel syndrome has a very frequent occurrence.
The carpal tunnel is a channel situated between the strongest ligament of the palm, the anterior annular ligament of the carp, the flexor retinaculum and the bones of the radiocarpal joint. The flexor tendons and the median nerve enter this tunnel at the radiocarpal joint.
The carpal tunnel syndrome is the consequence of the median nerve compression, caused by the anterior annular ligament or, in less common situations, by a synovitis or compressive tumor (lipoma, angiomas, etc.).
The first signs are characterized by tingling sensations in the first three fingers: thumb, index, medium and the radial half of the 4th finger. The tingling or burning sensation usually occurs during the night or in the morning, when waking up. Later on, there is pain in the hand that can go upward towards the forearm, elbow, arm and even the shoulder. In time, a loss of sensitivity can appear, accompanied by poor mobility, especially of the thumb and loss of the hand’s muscle strength (external thenar eminence).
The most common method for diagnosis confirmation is an electro-analysis called electromyography. Carried out by a neurologist, this exam records the quality of the electric current passing through the median nerve. This exam can state if the nerve damage is major and whether a surgical procedure is required or performing an infiltration in the first place would be enough.
This exam can detect a simultaneous compression of another nerve or an upward compression of the forearm, elbow or shoulder. If we let the carpal tunnel syndrome evolve, the median nerve will lose functionality and fingers will eventually lose their sensitivity, leading to the impossibility to catch fine objects or to perform certain thumb movements like holding a coin, for example.
In its beginning stage, one of the treatment methods to be taken into consideration is the infiltration of the carpal tunnel and wearing a rest splint at nighttime.
More frequently however, surgery becomes necessary as the syndrome worsens. The surgical procedure consists in sectioning the anterior annular ligament of the carp, which covers the carpal tunnel. According to prescriptions, there will be a preoperative review. Any drug containing aspirin should be avoided 10 days before surgery.
It is imperative to stop smoking before the surgery.
Type of anesthesia: the surgical procedure is performed under local-regional or general anesthesia, according to the patient’s, surgeon’s or anesthetist’s preference.
The procedure can be generally carried out in an outpatient basis, which means that you can leave the hospital or clinic on the same day after a few hours of medical observation, but in case of a general anesthesia, discharge will be made in the following days. Hence, the patient can return home as soon as his general health state allows him to.
Due to evolution, social, family or personal reasons, hospitalization can be taken into account.
Most of the plastic and cosmetic surgery practices are professionally done by Dr. Claudiu Filip.
The surgical procedure can be made endoscopically, leaving two small scars, or open, leaving a larger scar in the palm of the hand.
Healing usually takes about two weeks, and throughout this period, bandages are necessary.
Pain in the palm of the hand can last for a few weeks, which is sometime worrisome for the patients. With regard to the tingling sensations in the fingers, they will disappear rather quickly. In certain more severe cases, recovery may be longer.
Certain patients never regain complete sensitivity in the first three fingers due to the major nerve damage. The patients can start washing their hands 5-6 days postoperatively.
Activities are variably resumed depending on the type of the job, which is why we usually recommend a medical leave of about three weeks for manual activities. Driving is possible one week postoperatively.
Regaining strength in the hand may take more weeks, for example: opening a bottle.
Potential complications are the same as with any other surgical procedure:
- Postoperative infection
- Inflammatory response with swelling, secretion and joint stiffness which can sometimes evolve into algodystrophy. The latter complication requires an immediate consultation with your surgeon for specialized treatment.
In exceptional cases, wounds of the median nerve can occur, requiring new surgical interventions while also leaving painful sequelae with incomplete recovery of sensitivity.
In the end, the finger tingling sensation recurrence may be related to a relapse of the carpal tunnel, which is, again, extremely rare. In such a situation however, a consultation with your surgeon is mandatory, in order to search for another possible compression, upwards, in the forearm, elbow or the shoulder. Choosing a qualified plastic surgeon will ensure the fact that he/she has the necessary professional experience and skills to avoid such complications or to address them accordingly, if it’s the case.
You can find more information and postoperative recommendations during a consultation with Dr. Filip Claudiu.