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Carpal Tunnel Syndrome

March 17, 2016 0
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Before moving to Dubai I worked as a Plastic Surgeon and Hand Surgeon in Germany for almost 18 years. Amongst the most common hand surgeries I performed were Carpal Tunnel syndromes. At some days we would treat up to 6 patients for this.

What is Carpal Tunnel Syndrome?

Patients with this condition suffer from numbness of the first 3.5 fingers of the hand (thumb, index finger, middle finger and radial side of the ring finger). Sometime they can’t sleep a full night, because the pain in the concerned hand wakes them up mainly in the early morning hours. Usually, this condition is progressing and can lead untreated to a permanent numbness of the affected fingers and a weakness of the thump opposition, making it difficult to reach the tip of the little finger with the thumb. This thumb opposition is what distinguishes our hand from the ape’s hand.

What Are the Causes of Carpal Tunnel Syndrome?

The underlying cause for a Carpal Tunnel Syndrome is an increased pressure on the median nerve, which runs through a tight tunnel when entering the hand on the wrist level. The reasons for this increased pressure can be very different, but Caucasians seem to suffer more frequently from this condition than others. This explains the fact why this condition is so common in Europe and North America but not in Asia. The pressure leads to a slow but progressing reduction in the speed of the nerve conduction. This, in turn, reduces the sensation of the fingers affected and also the muscle responsible for the thump opposition.

Does Carpal Tunnel syndromes requires surgery?

If conservative therapy like splint treatments or cortisone injections don’t help a surgery is required to release the pressure from the nerve. This is been accomplished by dissecting a ligament called the transverse ligament in the wrist level which builds the “roof” of the carpal tunnel. In most cases, a surgery has to take place eventually, as most of the conservative treatments don’t cure the disease.

An exception is the pregnancy-related Carpal Tunnel Syndrome, which occurs during pregnancy and disappears usually a few weeks after delivery. The cause for this is the pregnancy-related water retention in the soft tissues of the body leading to increased pressure in the carpal tunnel, too. A small percentage of pregnant women develop this condition. It is best not to operate on them and count on for it to go away after delivery. Only in very severe cases with pain and function impairment, a surgery should be considered.

Walant Anesthesia and Carpal Tunnel Syndrome

Nowadays skilled hand surgeons perform this procedure in local anesthesia as an outpatient procedure in a matter of minutes. The most recent development for this surgery is the use of WALANT anesthesia which removes the need for an upper arm tourniquet, making the surgery even less stressful than before. The success rate is quite high and patients are usually relieved from pain the day after the surgery. However, if numbness was present, this may take up to 12 weeks to fully recover.

Look out for those who complain about not sleeping well anymore because they think they slept on their arm and this caused the hand to go numb, maybe they can be helped with a simple procedure.

 


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