Symptoms
Usually there is a sensory disturbance/numbness/abnormal sensation in the thumb, index and middle finger, sometimes also on the side of the ring finger that is adjacent to the middle finger. These can occur during manual exertion. Excessive bending and stretching of the wrist can also trigger the complaints. If this happens unconsciously during sleep, patients often awaken with the sensory disturbance/numbness/abnormal sensation. Nocturnal upper arm pain is also typical, as the brain cannot accurately localize the damage in the course of the nerve. In severe cases, the pressure damage to the nerve can also produce muscular dystrophy in the thumb, as these muscles are no longer fully controlled.
Complaints/Symptoms
Causes
Carpal tunnel syndrome is one of the most common neurological disorders. It involves pinching of the metacarpal nerve (median nerve) in the area of the wrist (Latin: carpus). There, the carpal bones form a U-shaped brace at the wrist, which is spanned by a very firm ligament on the inside of the wrist. Together with this, they form the so-called carpal tunnel. The tendons for the finger flexors and the metacarpal nerve run through this tunnel.
This tunnel is probably too narrow in some people from birth, so this problem runs in families. Carpal tunnel syndrome can also often be due to other causes, for example, after frequently overstretching the wrist or forearm, after bone fractures in this area, or caused by tendon sheath diseases, rheumatic diseases or metabolic diseases (thyroid and kidney diseases, diabetes). A special case is carpal tunnel syndrome during pregnancy, which is usually caused by increased water retention in the carpal tunnel and usually disappears after birth.
What we can offer
Treatment/progression
The treatment depends on the extent and duration of the symptoms. If there is persistent, increasing and painful to agonizing insensitivity and permanent loss of sensation or numbness of the fingers, your practitioner will recommend surgery. The operation is usually performed on an outpatient basis under local anesthesia by a specially trained hand surgeon. The ligament that restricts the top of the carpal tunnel is partially cut. This creates more space for the nerve and the blood vessels that accompany it, and relieves the pressure on them. In less severe cases, a splint can also bring improvement by immobilizing the wrist at night. In exceptional cases, injection of a cortisone preparation into the carpal tunnel may also be appropriate. Spontaneous improvement is also possible, especially if the hand is subjected to less strain. In most cases, however, the symptoms reappear and progress. Unfortunately, there are still many patients who do not come for surgery until severe nerve damage with constant numbness and muscular dystrophy of the ball of the thumb has already set in. The reason for this is often an incorrect diagnosis – an assumption that the symptoms are coming “from the spine.” Even at this advanced stage, very good results can still be achieved with a surgical intervention, although complete recovery is no longer guaranteed.
