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Praxis für Neurochirurgie
Dr. Elmar Patz
Dr. Patz with CT scan

Nerve compression syndrome of the median nerve in the hand (carpal tunnel syndrome)

The carpal canal, the most important and most common point of compression along the median nerve, is formed by the carpal wrist bone and the ligament (flexor retinaculum) extending crosswise over it. This tunnel not only contains the median nerve but also the tendons of the digital flexor muscles of the fingers. Thickening of the flexor retinaculum compresses the nerve at the bottleneck present here.
Carpal tunnel syndrome is the most common compression syndrome affecting the peripheral nerves. Some 8-10% of the population suffer from this syndrome, which generally occurs on both sides of the body, although it tends to affect the dominant hand. Women are some three times more likely to have carpal tunnel syndrome than men, and it also runs in families.

Symptoms:

Typical symptoms are numbness and a tingling sensation in the affected hand at night. They can also be triggered by certain movements. Shaking out the hand will offer relief from pain. Increasing compression and damage to the nerve will intensify and prolong such abnormal sensations, especially in the tips of the 3rd and 4th fingers, and later on in the 1st and 2nd fingers as well, accompanied by significant problems with fine movements.

Diagnosis:

Measurement of the nerve transmission speed is carried out to confirm this diagnosis.

Surgery:

Surgery is recommended with a clear-cut diagnosis when symptoms continue to worsen, especially if they are preventing the patient from getting a good night's rest or they are experiencing neurological disorders (e.g. palsy and numbness).

At our practice we only carry out open surgery in this case as we consider it superior to the endoscopic technique (keyhole surgery) in this context. An incision measuring 3-4 cm in length is made in the palm under local anaesthetic and the ligament cut sharply to create more space. A pressure bandage is then applied for one day. The patient should start exercising the fingers and hand straightaway as giving the hand too much rest is harmful and may result in serious impairment of mobility.

Also see:

» Slipped disc
» Nerve compression syndrome of the elbow
» Bony narrowing of the spinal canal
» Chronic backache

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Praxis für Neurochirurgie · Dr. Elmar Patz · Boxgraben 95 · 52064 Aachen