Carpal tunnel syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is the most common peripheral nerve compression syndrome. It develops when the median nerve is compressed in the carpal tunnel, which is a confined space located on the inner side of the wrist.

A characteristic symptom is numbness in the thumb, index finger, middle finger, and half of the ring finger. The discomfort may be accompanied by pain, which often intensifies at night. As the disease progresses, hand weakness may also occur, affecting dexterity and the ability to perform precise movements.

When is carpal tunnel syndrome surgery performed?

In advanced stages of the disease, surgery is the only effective treatment method. Its goal is to cut the structures causing pressure on the median nerve and increase the space within the carpal tunnel.

Qualification for surgery takes place during a consultation with a doctor. The assessment of symptoms and the degree of nerve damage is of fundamental importance. Based on this, the doctor decides on the necessity of the procedure and discusses the next steps with the patient.

How to prepare for carpal tunnel syndrome surgery?

The first stage of preparation is diagnostics to assess the condition of the median nerve. The primary test is an EMG, or nerve conduction study, which makes it possible to determine the degree of nerve damage.

In some cases, the doctor may also recommend a wrist ultrasound. This examination allows for visualization of the compression site and changes in the nerve structure.

During the qualification consultation, the doctor conducts a detailed medical history and orders basic laboratory tests. The patient should provide information about any medications they are taking, especially those that affect blood clotting. The method and timing for discontinuing these medications must be agreed upon with the doctor in each individual case – do not stop prescribed treatment on your own.

Before the surgery, it is also necessary to stop using nicotine products. You must remove any jewelry from the hand being operated on. It is also recommended to remove artificial nails beforehand.

How is carpal tunnel syndrome surgery performed?

The surgery is performed under local infiltration anesthesia or regional anesthesia. In the latter case, a brachial plexus block is used to numb the limb being operated on.

The procedure is performed in a bloodless field. To achieve this, a pressure cuff is placed on the arm. The surgeon then cuts the structures causing pressure on the median nerve—the flexor retinaculum and the forearm fascia. This releases the nerve and increases the space available to it.

At the end of the surgery, a thin drain is left in the wound. It is removed the following day during the dressing change.

Recovery after carpal tunnel surgery

Immediately after the procedure, the hand is immobilized in a splint. The wrist is kept in a neutral position for about 2.5 weeks. This immobilization promotes proper healing of the structures cut during the surgery.

In the initial period after the procedure, the hand should be kept elevated, roughly at heart level. A sling helps with this. Positioning the limb in this way limits the development of post-operative swelling.

Stitches are usually removed after about 14 days. Afterward, you should begin scar massage and perform the exercises recommended by the surgeon. Recommendations should be tailored to the stage of healing and the individual condition of the hand.

A return to daily activities should be gradual. The pace of increasing activity depends on the healing process, the extent of the prior nerve damage, and the patient's individual capabilities.

When do numbness and pain subside?

Pain and numbness may decrease immediately after the nerve is released. However, this does not mean that all symptoms will resolve at the same time for every patient.

Full recovery of sensation is linked to nerve regeneration and may therefore take anywhere from a few weeks to several months. The time required to regain sensation depends primarily on the severity of the condition, the patient's age, and any coexisting medical conditions.

How to care for a surgical scar?

Once the stitches have been removed and you have received approval from the surgeon, you should begin scar massage. This should be performed according to the instructions provided, as should the exercises that support the gradual return of hand function.

The scope of massage and exercises may be modified depending on the healing process. Do not increase the intensity of post-operative care on your own if it causes discomfort or raises concerns.

Contraindications for carpal tunnel surgery

The procedure should not be performed in cases of:

• active skin infection in the area of the hand to be operated on,
• uncontrolled chronic conditions, such as diabetes or hypertension,
• blood clotting disorders.

The final decision regarding surgical eligibility rests with the qualifying physician. During the consultation, the doctor considers test results, current health status, and information gathered during the medical interview.

Ulnar nerve entrapment at the elbow, also known as cubital tunnel syndrome, is a condition resulting from pressure on the nerve at the elbow level. The ulnar nerve passes through a specific groove in this area, where it can be susceptible to compression and irritation.

The causes of the condition can vary. Compression may be related to anatomical factors, repetitive strain, or inflammation. These changes disrupt the proper functioning of the nerve, leading to sensory issues and, in more advanced cases, weakness of the hand muscles.

What are the symptoms of ulnar nerve entrapment?

Characteristic symptoms include pain and numbness in the little and ring fingers (the fifth and fourth digits). Sensory disturbances in these fingers may also occur.

As the condition progresses, grip strength may weaken. In more advanced stages, atrophy of the intrinsic hand muscles, which are responsible for some precise finger movements, may also occur.

The extent of the symptoms and the degree of nerve damage are assessed by the surgeon during the consultation and based on diagnostic test results.

When is surgery considered?

The decision to proceed with surgery is made by the surgeon after examining the hand, taking a detailed medical history, and analyzing test results. The degree of nerve damage and the extent of sensory disturbances and hand weakness are significant factors.

The goal of the surgery is to relieve pressure on the ulnar nerve. Releasing the nerve can reduce pain and numbness, and create conditions for gradual sensory regeneration and improved hand function.

What does surgery for ulnar nerve entrapment involve?

The surgery involves cutting the structures causing pressure on the ulnar nerve within the groove at the elbow level. The scope of the procedure is adjusted based on the anatomical conditions and the type of changes identified during the qualification process.

In some cases, simply releasing the nerve may not be enough. It may be necessary to move it out of its current groove and place it in a new position. This procedure is known as anterior subcutaneous transposition of the ulnar nerve.

The procedure is usually performed under regional anesthesia, specifically using a brachial plexus block. This allows the operated limb to be numbed.

A pressure cuff is placed on the arm to allow the procedure to be performed in a bloodless field. After the surgery, a thin drain is left in the wound. It is removed the following day during the dressing change. The operated area is secured with a cocoon dressing that keeps the elbow bent.

How should you prepare for surgery?

Comprehensive diagnostics are necessary before the procedure. An EMG test helps assess the degree of nerve damage and functional impairment. An ultrasound, meanwhile, allows for visualization of the nerve structure at the site of compression, which helps in planning the scope of the surgery.

During the consultation, the surgeon takes a detailed medical history, examines the hand, and analyzes diagnostic results. They will also order the basic laboratory tests required for the procedure.

Before surgery, medications that affect blood clotting may need to be temporarily discontinued or adjusted. This decision is always made by a doctor. Do not stop prescribed treatment on your own. During your consultation, be sure to inform your doctor about all medications you are taking.

Preparation also includes:

• stopping the use of nicotine products,
• remove jewelry from the hand being operated on,
• it is recommended to remove artificial nails.

Recovery after ulnar nerve surgery

Immediately after the procedure, the surgical area is secured with a cocoon dressing that keeps the elbow flexed. The arm should be worn in a sling with the elbow bent for about 2.5 weeks. This ensures proper conditions for the healing of structures cut during the surgery.

The drain left in the wound is removed the following day during the dressing change. Stitches are removed after approximately 14 days.

Pain associated with nerve compression often subsides very quickly. However, the return of normal sensation requires nerve regeneration, which can take anywhere from a few weeks to several months. The recovery time depends on factors such as the severity of the condition, the patient's age, and any coexisting medical conditions.

Exercises and hand rehabilitation

Appropriate physical exercises are important for recovery. Their scope should be tailored to the healing stage and performed according to the instructions provided.

A key part of the recovery process is gradually working on grip strength. Exercises support the restoration of limb mobility and hand function, but you should not increase their intensity on your own.

The pace of recovery is individual. It depends primarily on the degree of nerve damage before surgery, the rate of nerve regeneration, the patient's age, underlying conditions, and consistent adherence to prescribed exercises.

What results can be expected after surgery?

The goal of the surgery is to decompress the ulnar nerve. This can reduce pain and numbness in the little and ring fingers, while creating the conditions for a gradual improvement in sensation and hand strength.

Pain may subside quickly, but nerve regeneration takes longer. Full sensory recovery may take several weeks or months.

The extent of the results depends on the severity of the condition prior to surgery. For this reason, the timeline and recovery process may vary from patient to patient.

Contraindications for surgery

The procedure is contraindicated in cases of:

• active skin infection in the surgical area,
• uncontrolled chronic conditions, such as diabetes or hypertension,
• blood clotting disorders.

The final decision regarding surgical qualification is made by the surgeon. They take into account the condition of the nerve and the affected limb, diagnostic results, underlying medical conditions, and the patient's overall health.