carpal tunnel in Tunisia
Definition of Carpal Tunnel
Carpal tunnel syndrome, also called median nerve compression, is a condition that causes numbness, tingling, or weakness in the hand.
This happens due to pressure on your median nerve, which runs the length of your arm, passes through a passage in your wrist called the carpal tunnel, and ends in your hand. The median nerve controls the movement and sensation of your thumb and the movement of all your fingers except your little finger.
Symptoms of Carpal Tunnel
Symptoms of carpal tunnel include:
Burning, tingling, or itching numbness in your palm and thumb or index and middle fingers
Weakness in the hand and difficulty holding things
Shock sensations that move through your fingers
Tingling that travels up your arm
You may first notice that your fingers "fall asleep" and become numb at night. This usually happens because of the way you hold your hand while sleeping.
In the morning, you may wake up with numbness and tingling in your hands that may travel up to your shoulder. During the day, your symptoms may appear when you hold something with your wrist bent, such as when driving or reading a book.
Treatment of Carpal Tunnel
Although it is a gradual process, for most people, carpal tunnel syndrome will worsen over time without any form of treatment. For this reason, it is important to be evaluated and diagnosed early by your doctor. In the early stages, it may be possible to slow or stop the progression of the disease.
Non-Surgical Treatment of Carpal Tunnel
If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be relieved without surgery. If your diagnosis is uncertain or if your symptoms are mild, your doctor will first recommend non-surgical treatment. Non-surgical treatments may include:
Bracing or splinting: Wearing a brace or splint at night will prevent you from bending your wrist during sleep. Keeping your wrist in a straight or neutral position reduces pressure on the nerve in the carpal tunnel. It may also be helpful to wear a splint during the day when doing activities that worsen your symptoms.
Non-steroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen and naproxen can help relieve pain and inflammation.
Activity changes: Symptoms often occur when your hand and wrist are in the same position for too long, particularly when your wrist is flexed or extended. If your work or recreational activities worsen your symptoms, changing or modifying these activities may help slow or stop the progression of the disease. In some cases, this may involve making changes to your workplace or workstation.
Nerve gliding exercises: Some patients may benefit from exercises that help the median nerve move more freely within the confines of the carpal tunnel. Specific exercises may be recommended by your doctor or therapist.
Steroid injections: Corticosteroid, or cortisone, is a powerful anti-inflammatory that can be injected into the carpal tunnel. While these injections often relieve painful symptoms or help calm a flare-up of symptoms, their effect is sometimes only temporary. A cortisone injection may also be used by your doctor to help diagnose your carpal tunnel syndrome.
Surgical Treatment of Carpal Tunnel
If non-surgical treatment does not relieve your symptoms after a period of time, your doctor may recommend surgery. The decision whether to have surgery depends on the severity of your symptoms - how much pain and numbness you have in your hand. In long-standing cases with constant numbness and wasting of the thumb muscles, surgery may be recommended to avoid irreversible damage.
Procedure of Carpal Tunnel Surgery
The surgical procedure performed for carpal tunnel syndrome is called "carpal tunnel release." There are two different surgical techniques for doing this, but the goal of both is to relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel. This increases the size of the tunnel and decreases pressure on the median nerve.
In most cases, carpal tunnel surgery is performed on an outpatient basis. The surgery may be done under general anesthesia, which puts you to sleep, or under local anesthesia, which numbs only your hand and arm. In some cases, you will also receive a light sedative intravenously (IV) inserted into a vein in your arm.
Open carpal tunnel release: In open surgery, your doctor makes a small incision in the palm of your hand and looks inside your hand and wrist through this incision. During the procedure, your doctor will divide the transverse carpal ligament (the roof of the carpal tunnel). This increases the size of the tunnel and decreases pressure on the median nerve. After surgery, the ligament may gradually grow back, but there will be more space in the carpal tunnel and the pressure on the median nerve will be relieved.
Endoscopic carpal tunnel release: In endoscopic surgery, your doctor makes one or two small skin incisions - called portals - and uses a miniature camera - an endoscope - to see inside your hand and wrist. A special knife is used to divide the transverse carpal ligament, similar to the open carpal tunnel release procedure.
The results of open surgery and endoscopic surgery are similar. There are benefits and potential risks associated with both techniques. Your doctor will talk with you about which surgical technique is best for you.
Recovery after Carpal Tunnel Surgery
Immediately after surgery, you will be encouraged to elevate your hand above your heart and move your fingers to reduce swelling and prevent stiffness.
You should expect pain, swelling, and stiffness after your procedure. Minor pain in the palm may last from several weeks to several months.
Grip and pinch strength usually return about 2 to 3 months after surgery. If the condition of your median nerve was poor before surgery, however, grip and pinch strength may not improve for about 6 to 12 months.
You may need to wear a splint or wrist brace for several weeks. You will, however, be allowed to use your hand for light activities, taking care to avoid significant discomfort. Driving, self-care activities, and light lifting and gripping may be allowed shortly after surgery.
Your doctor will talk with you about when you will be able to return to work and whether you will have any restrictions on your work activities.
Possible Complications after Carpal Tunnel Surgery
Although complications are possible with any surgery, your doctor will take steps to minimize the risks. The most common complications of carpal tunnel release surgery include:
Bleeding
Infection
Worsening or nerve injury
What to Expect from Carpal Tunnel Surgery
For most patients, surgery will improve the symptoms of carpal tunnel syndrome. However, recovery can be gradual and complete recovery may take up to a year.
If you have significant pain and weakness for more than 2 months, your doctor may refer you to a hand therapist who can help you maximize your recovery.
If you have another condition that causes pain or stiffness in your hand or wrist, such as arthritis or tendinitis, this may slow your overall recovery. In long-standing cases of carpal tunnel syndrome with severe loss of sensation and/or muscle wasting around the base of the thumb, recovery will also be slower. For these patients, complete recovery may not be possible.
Occasionally, carpal tunnel syndrome can recur, although this is rare. If this happens, you may need additional treatment or surgery.