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Carpal Tunnel Syndrome (CTS)

What is Carpal Tunnel Syndrome (CTS).
Carpal Tunnel Syndrome is a condition in which a nerve in the wrist becomes trapped. It is caused by tissue becoming swollen around the flexing tendons and results in numbness and a tingling sensation in the arm, hand and fingers. There is a tunnel in the wrist which is known as the carpal tunnel. The median hand nerve and the nine flexing tendons run from the lower arm through this tunnel into the hand.



What is the cause?
The cause is generally unknown. Possible causes can be:

  • over a long period of time, making the same hand movement (over-use syndrome)
  • an infection in the tendon(s): the tissues (synovial membranes ) surrounding the tendons   become swollen
  • sprains, fractures and inflammations in the joints (arthritis) can also lead to narrowing of the    tunnel
  • the condition often occurs in patients with rheumatism, diabetes or an under-active thyroid   gland
  • pregnancy: a pregnant woman often retains a large amount of water. As a result, a swelling   can occur in the synovial membranes with accompanying symptoms. Generally, in this case,   the Carpal Tunnel Syndrome disappears spontaneously after the pregnancy.

The symptoms are usually worse at night. Various activities, in which the hand is used in a particular position, such as driving a car, riding a bicycle or reading the newspaper can also bring on the symptoms.  

What are the symptoms?
These can vary considerably. You could, for example, be troubled by:

  • a numb or tingling sensation in one or both hands, particularly in the palm of the hand, the    thumb, index, middle and ring finger; never in the little finger. Sometimes there is pain in the    lower and upper arm and/or shoulder.
  • loss of strength in your hand and sensory disturbance in the fingertips causing you to drop  things easily.
  • if you have been troubled by the condition for a long time and, as a result, there has been a   prolonged pressure on the nerve, the hand function will become less efficient but it will not be   so painful. In the most severe case, permanent loss of sensation can occur and the muscles in   the ball of the thumb can shrink (see drawing 2).  

Diagnosis
In order to make the correct diagnosis, you must describe your symptoms precisely to the doctor. He will need to know in detail about how you use your hand, your profession, whether you have had previous damage to your hand or wrist and all your symptoms. Sometimes, further examination will be needed. This can be:

  • an X-Ray photograph to check that there is no other cause such as a fracture or inflammation   in a joint.
  • a blood test if your doctor suspects that another illness (e.g. rheumatism) has led to the   occurrence of Carpal Tunnel Syndrome.
  • an examination of the nerve-channel and a recording of the electrical activity in a muscle   (electromyography - E.M.G.) so as to ensure that the nerve is not trapped elsewhere. This examination is performed  by a neurologist.  



Treatment
If Carpal Tunnel Syndrome is confirmed, there are various possible treatment methods. Depending on the cause, your doctor will advise you on various treatments. These could be:

  1. Adaptation of certain activities, aimed at decreasing the pressure on your hand and wrist.    The trapped nerve then has more space.
  2. Holding the wrist straight; the swelling can diminish and there is more space around the nerve.
  3. Wearing a wrist brace at night can decrease your symptoms and improve your sleep. If the     symptoms continue to be severe or do not disappear, an operation may be necessary.

Aim of the operation
To widen the tunnel so as to release the trapped nerve, possibly in combination with cleaning the membranes surrounding the tendons.

Preparation
Before the operation, you must take no blood-thinning medication. You should inform your doctor, beforehand, if you are taking sintrom(mitis) or painkillers containing aspirin such as APA, aspirin, ascal, asprobruis, naprosine, diclofenac or sinaspril. Paracetamol can be taken.  

Important!
On the day of the operation, you should make sure that:

  • your hands are absolutely clean
  • your nails are well-scrubbed and free of varnish
  • you are not wearing rings or any other hand jewellery

The operation
The operation takes no more than half an hour. You will be given a local anaesthetic in the palm of the hand, wrist or in the arm.
With a local anaesthetic, a blood-pressure meter will, for a short time, be pumped up around your arm. A general anaesthetic is usually not necessary.  

The operation itself
An incision will be made in the tendon plate on the palm of your hand, which forms the “roof” of the tunnel (see drawing 3). In this way, the tunnel will be widened and the nerve will be released from its entrapment.



After the operation
The hand will be bound in a pressure bandage. You must hold your hand up high and will, therefore, have to wear a sling for a few days. When you go to bed, lay your hand on a pillow in such a way that the wrist is higher than the elbow.  

The pain, resulting from the operation, usually disappears quickly. The scar area can, however, remain sensitive over a period of weeks or even months. The tingling at night soon eases off. It can also be ages before the strength in your hand and wrist is back to normal.
Occasionally, the symptoms remain after the operation. If the wrist is overtaxed again after the operation, Carpal Tunnel Syndrome can recur.

Returning to work after the operation
It will be about 4 to 6 weeks before the tunnel recovers. During that time, you must not overtax the hand. You must not wring your hand by, for instance, turning tops of jam jars or uncorking bottles. Your return to work depends strongly on the type of work you do; household, office etc..  

Important warning! if you do have severe pain or there is any discolouration of your hand in the post-operative period, you must immediately get in touch with your plastic surgeon (telephone: 070 - 312 44 99) or Bronovo Hospital (telephone: 070 - 312 41 41).  
Finally
If, having read this leaflet, you still have any questions or comments, please do not hesitate to take these up with your doctor.