CARPAL TUNNEL SYNDROME
Wrist is a narrow part of the upper limb where tendons and nerves to the hand and fingers are crowded. A fibrous sheath holds all these structures . The area under this fibrous sheath is called carpal tunnel.
The structure which is superficial and prone for pressure inside the carpal tunnel is the median nerve. Median nerve helps in providing sensation to the thumb, index finger, middle finger and half of the ring finger. It also provides nerve supply to muscles of the thumb. Compression of the median nerve under the carpal tunnel is called carpal tunnel syndrome. Carpal tunnel syndrome produces altered sensations in the fingers in the initial stages and weakness of thumb in the late stages.
Severity of carpal tunnel is assessed with a combination of clinical evaluation and nerve conduction studies ( NCS).
Mild carpal tunnel syndromes are managed with nerve gliding exercises, splinting and medications.
Moderate carpal tunnel syndromes are managed with corticosteroid injections, in suitable patients. However, given its temporary relief of symptoms and finite risk for nerve injury, in our practise corticosteroid injection is not indicated routinely.
Severe carpal tunnel syndromes are managed with surgery.
We use a mini open technique for carpal tunnel release , with minimal scar. We have undergone extensive training in endoscopic carpal tunnel releases from France. Advantage with endoscopic carpal tunnel release is a single stitch compared to three stitches in mini open carpal tunnel release and more aesthetic appearance of scar.
This is a day care procedure . Patients can undergo the procedure and go home on the same day . Surgery is done under regional anaesthesia ie ; the patient will be awake but feels no pain. After surgery a removable splint is provided which is advised to use for three weeks. He or She can start using the hand from the next day. Sutures are removed after 12 days.