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Carpian Tunnel Syndrome Treatment

Article written by: ANDREI BOGDAN, MD, Orthopedics-traumatology doctor

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For all traumatic or chronic diseases of the musculoskeletal system, the Centrokinetic private clinic in Bucharest is prepared with an integrated Orthopedic Department, which offers all the necessary services to the patient, from diagnosis to complete recovery.

The Department of Orthopedic Surgery of Centrokinetic is dedicated to providing excellent patient care and exceptional education for young physicians in the fields of orthopedic surgery and musculoskeletal medicine.

Centrokinetic attaches great importance to the entire medical act: investigations necessary for correct diagnosis (ultrasound, MRI), surgery, and postoperative recovery.

Discover the open MRI imaging center in our clinic. Centrokinetic has a state-of-the-art MRI machine, dedicated to musculoskeletal conditions, in the upper and lower limbs. The MRI machine is open so that people suffering from claustrophobia can do this investigation. The examination duration is, on average, 20 minutes.

The carpal tunnel is located on the dorsal side of the wrist and consists of the carpal (hand) bones and the transverse carpal ligament. The carpal bones form a groove, and the ligament transforms this groove into a canal. The median nerve passes through the carpal tunnel and reaches from the forearm region to the palmar region. It sensitively innervates the thumb, forefinger (index finger), long finger (middle finger), and half of the ring finger on the palmar face, but also has an innervation area on the dorsal face of these fingers.

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It also sends a nerve branch to control the tender muscles of the thumb. The tender muscles help the movement of the thumb and allow you to touch with the tip of the thumb, the tip of each finger from the same hand, a movement called opposition.

The median nerve and the flexor tendons pass through the carpal tunnel. The median nerve is located on the top of the tendons, just below the transverse carpal ligament. Flexor tendons are important because they allow the fingers, thumb, and hand to move, such as when we catch something. The tendons are covered by a synovial, slippery membrane that allows the tendons to slide side by side as they contract and relax to move their hand and fingers.

Any condition that decreases the size of the carpal tunnel or increases the size of the tissues inside the tunnel can lead to symptoms of carpal tunnel syndrome. The carpal tunnel cannot expand (the walls are inextensible), so any condition that causes abnormal pressure in the carpal tunnel can cause symptoms of carpal tunnel syndrome. Also, any increase in pressure in the carpal tunnel can reduce blood flow to the nerve, leading to loss of nerve function.

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Usually, this condition occurs in patients who perform repetitive, physical movements with their hands, which over time leads to swelling (thickening) of the muscle tendons and increased pressure on the median nerve.

However, scientists believe that other factors, such as smoking, obesity, and caffeine consumption, may actually be more important in the development of carpal tunnel syndrome.

The treatment of carpal tunnel syndrome depends on the degree of damage to the median nerve (following the EMG investigation and ultrasound or fist MRI) and the patient's symptoms. Compared to the fact that the vast majority of patients develop this condition, following a professional activity, an activity that cannot be interrupted, the treatment is surgical, most of the time.

Surgical technique

Under locoregional anesthesia (brachial plexus or axillary plexus) or general anesthesia, an incision of about 1.5-2 cm is made on the dorsal face of the fist. A thorough dissection of the subcutaneous tissue is performed and the tendon of the long palmar muscle is highlighted.

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The tendon fibers are dissected and penetrate the transverse ligament of the carpus. The ligament is sectioned longitudinally, taking great care to protect the median nerve. Subsequently, it is checked whether the nerve has been released proximal and distal, along the entire length of the carpal tunnel.

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Persistent pain and numbness may not go away immediately after surgery. Sometimes numbness can persist for a year after surgery. Surgery is needed both to relieve symptoms and to decompress the nerve to save it from permanent damage. Our medical team can examine you by EMG and fist ultrasound, to make a correct decision regarding the treatment.

A surgical alternative is an arthroscopic technique.
  Our medical team performs this technique, but in terms of the accuracy of the medical act, the open technique is simpler, faster, and safer.

Post surgery

After the operation, the patient remains hospitalized for 1 day. He will receive pain medication and antibiotics during his hospitalization. The operated limb is not immobilized, the patient is advised not to make hand movements, the elbow and fingers.

Patients will wear a compressive bandage on the fist for 5 days and will use a special orthosis, which can be easily removed for personal hygiene. Patients can return to family and professional activities quickly, up to 4-6 weeks.

At home

Although recovery after this operation is much faster than classic intervention, it will still take a few weeks for you to fully recover. You should expect pain and discomfort for at least a week postoperatively.

You must be careful not to force the operated area by making very wide flexion and extension movements in the first weeks because the pain and discomfort can worsen. You can take a bath, but without wetting the bandage and incisions. The threads are suppressed at 14 days postoperatively.

At 6 weeks postoperatively, an x-ray is necessary to see how the affected joint heals. Driving is allowed after 6 weeks, and hard physical work after 12-16 weeks.

Physical therapy plays a very important role in the rehabilitation program, and the exercises must be followed by a physical therapist until the recovery period ends.

It is very important to follow the recovery program strictly and seriously for the surgery to be a success. Our medical team works, on average, 18-24 weeks with the patient until the complete recovery of the operated area.

Following any surgery, medical recovery plays an essential role in the social, professional, and family reintegration of the patient. Because we pursue the optimal outcome for each patient entering the clinic, recovery medicine from Centrokinetic is based on a team of experienced physicians and physical therapists and standardized medical protocols.

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