Carpal tunnel syndrome

What is carpal tunnel syndrome?

In the area of the wrist there is a passageway (carpal tunnel) for the flexor tendons of the fingers and the median nerve (n. medianus). The median nerve supplies the thumb, index and middle fingers and half of the ring finger with sensitivity and controls part of the thumb muscles in the hand. The carpal tunnel is bounded on the back of the hand by the carpal bones and on the front of the hand by a ligament. If there is an increase in pressure in the carpal tunnel, the nerve is also compressed. This can lead to a circulatory disorder in the nerve and thus to a functional impairment. If the nerve is exposed to increased pressure over a longer period of time, this can lead to permanent damage with severe loss of sensation and muscle atrophy in the ball of the thumb area.

What are the causes of carpal tunnel syndrome?

Possible causes of carpal tunnel syndrome are

• Increased tissue fluid (pregnancy, hormonal disorders).
• Inflammation and swelling of the flexor tendons.
• Long-lasting work with vibrating devices.
• Degenerative changes of the wrist. Wrist fractures.
• Tumors or tumor-like changes (e.g. ganglion) in the carpal tunnel.

What are the symptoms of carpal tunnel syndrome?

Typical symptoms are numbness of the above-mentioned fingers, initially during exertion and/or at night, later also constantly, numbness, pain in the hand, occasionally radiating to the forearm and loss of strength in the arm. The discomfort can often be alleviated by shaking hands and self-massage.

How is the diagnosis made?

A suspected diagnosis is made on the basis of the patient’s medical history and clinical findings. To confirm the diagnosis, an electrophysiological examination is carried out by the neurology department to test how well the nerve still conducts electrical impulses. If there is a suspicion that a degenerative change in the joint or, for example, a ganglion in the carpal tunnel is responsible for the increase in pressure, an X-ray or ultrasound can be carried out.

What are the treatment options for carpal tunnel syndrome?

If the symptoms and electrophysiological changes are only minor, conservative therapy can be carried out without surgery. If conservative treatment is of no use, or if there are already pronounced sensory disturbances, muscle atrophy and/or a significant deterioration in the nerve’s conduction capacity, surgery is necessary.