About Carpal Tunnel Syndrome (5)
Carpal tunnel syndrome is a common condition. It is the oppression of the median nerve by a firm, swollen carpal ligament as it passes through the carpal tunnel at the entrance to the palm of the hand.
Symptoms of carpal tunnel syndrome typically include pain and tingling in the palm of the hand and especially the fingers. Patients often describe the change in sensitivity as a feeling of numbness, swelling and stiffness of the fingers. Difficulties may occur at rest, typically at night waking the patient from sleep. In daytime activities, the affected people report increased difficulty, such as during manual activities, cycling, driving a car or pushing a stroller, when there is increased pressure on the nerve from the exterior. Other complaints in more advanced stages of the condition include deterioration of fine motor skills of the fingers, weakening of grip, sometimes with objects falling out of the hand.
In the endoscopic surgical technique, a short cutaneous incision (10-15mm) in the wrist crease is sufficient and with the help of special instruments we selectively cut only the carpal ligament while sparing all other superficial structures of the hand. The scar area is not in a strained area and therefore heals better and in the vast majority of cases does not cause any discomfort to the patient. As a result, the minimally invasive endoscopic approach results in faster recovery and return to routine activities, work and hobbies.
As you can understand, everything in medicine and surgery in particular can bring its own negatives and complications. In endoscopic surgery of carpal tunnel syndrome, we rarely encounter postoperative subcutaneous hematoma (blood spurt, bruise or bruising if you prefer). Of course, inflammation in the surgical area or mechanical damage to the released median nerve cannot be completely excluded.
The use of endoscopic surgery is vast in diagnosing CT syndrome, however, we do not recommend it to patients after fractures or other deformities of the wrist region, in severe atrophy of the thumb muscles and the resulting significant muscle weaknesses and in the
need for reoperation after previous unsuccessful surgery. In these cases, we recommend and perform surgery using the classic open technique. Exceptionally, a situation may arise during the surgical procedure which for some reason (insufficient visibility of the surgical area, unfavourable anatomical conditions) does not allow the procedure to be performed completely using the endoscopic technique and it is necessary to use the conventional surgical technique in order to maintain safety and reliability of the operation for the patient.
After Surgery (2)
You can expect the pain to disappear or be significantly relieved within the first two days after surgery, and the tingling sensation in the fingers to subside quickly, but you will usually have to wait much longer (weeks to months) for the sensitivity of the fingers and hand to improve, as well as the muscle strength and dexterity of the affected hand to recover. Some patients with very severe preoperative hand disability may have irreversible nerve involvement and unfortunately, functional improvement no longer occurs, but the pain improves reliably with nerve release.
You can cautiously engage the hand in activities after a few days, but avoid putting pressure on the wrist-palm junction area (gripping objects, opening doors by pressing the handle, etc.).
In the event of postoperative pain in the wound or palm area, do not hesitate to use commonly available analgesics.
IMMEDIATELY AFTER SURGERY
Patients leave with a sterile wound cover and an elastic bandage around the wrist, which can be removed on the same evening as the operation. After that, the wound is only
covered with a sterile dressing. It is important to maintain the sterility of the wound in the first postoperative days and therefore we do not recommend uncovering the wound in the first 2-3 days. In case of tearing, significant staining, soaking of the dressing, its sterile replacement is necessary if possible.
The hand can be gradually involved in light activities from the next day of surgery, at first very carefully. A raised position of the operated limb and occasional free movement of the fingers is very helpful. If your hand hurts, take a common analgesic (Ibalgin, Aulin, Paralen, etc.).
The anti-swelling drug Aescin is preferably taken at a dose of 2-2-2 for 10 days and is available without a prescription from a pharmacy.
AFTER THE REMOVAL OF STITCHES
Approximately on the 10th postoperative day, we remove the stitches and cover the healed wound with a small cover, which can be removed the next day.
Gradually, you can engage your hand more and more in everyday activities, the time interval from surgery to full use of the operated hand is individual and ranges from 2 to 6 weeks.
Most of our patients do not need special rehabilitation and it is completely sufficient to do pressure massage of the wrist-palm transition with the non-operated hand. Exercise with repetitive squeezing of a softer massage ball is usually an advantage.
We will instruct you on all the essential information during surgery and postoperative check-ups.
The diagnosis of carpal tunnel syndrome must be confirmed preoperatively by the EMG (electromyographic) finding, which you will need to book an appointment with us either by email: email@example.com or phone: 604226996.
If you have an evident clinical suspicion of carpal tunnel syndrome and you still do not have an EMG, we will help you to obtain one.
Before the surgery itself, we induce numbing (local anaesthesia) of the operated hand. Just above the wrist, we infiltrate the area around the median nerve with local anaesthetic and wait until the anaesthesia has fully set in so that you are not in pain. In the meantime, we will prepare everything necessary for your surgery. Once you are comfortably seated in the operating room, we will put a “tourniquet” on your arm, and carefully sanitize and splint your arm and part of your forearm. We then inflate the tourniquet to achieve a bloodless surgical field. Through a short skin incision in the wrist area and subsequent preparation, we enter the carpal tunnel and slightly widen it with special instruments. We insert an endoscopic knife with integrated optics and cut the carpal ligament under visual inspection. Before removing the endoscope we check for complete release of the median nerve and finish the surgery by suturing the wound with a skin suture. The surgery itself takes about 10min, with the necessary preparations, and time to get the local anaesthetic perfectly in place, you will spend a total of 45-60min with us.
Before we say goodbye, we will instruct you on the early and longer-term post-operative regime. Don’t worry, you’ll also get everything you need to know in hard copy, just in case something slips your mind on the way home.