Carpal tunnel syndrome (CTS) is a compression of the median nerve in the area of the carpus on the underside of the wrist. At this point, the median nerve, together with nine tendons, runs through the carpal tunnel, a canal in the wrist that is surrounded by bone on three sides, and a strong transverse carpal ligament on the fourth, the approx. 2 cm wide retinaculum flexorum. Inflammation or swelling of the flexor tendon in the carpal tunnel, fractures of the hand or wrist, or swelling of tendon tissue through rheumatoid arthritis can cause swelling of these structures inside the tunnel, thus affecting the nerve as the most sensitive structure. Typical symptoms of this compression of the nerve include numbness and a tingling in the index, middle and ring fingers, sometimes accompanied by a sensation of intense burning pain. These symptoms are particularly strong at night or when the hand is kept in the same position for extended periods of time, e.g. when driving.
Nerves really are most delicate structures. An infringement/compression persisting over long periods of time can result in functional impairments, some of which may be irreversible.
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| Anatomical structures of the hand | After the division of the transverse carpal ligament (retinaculum) in the carpal tunnel, the median nerve is no longer compressed. |
Treatment of carpal tunnel syndrome
If symptoms have only been present for a short time or if the compression is mild, non-surgical treatment may be tried. The most beneficial option is a wrist brace or splint to be worn at night, accompanied by treatment with anti-swelling (anti-inflammatory) drugs. Surgery is the only recommended option for stronger forms of CTS.
Surgical treatment of CTS involves freeing the median nerve from its compression by cutting the tendon that forms the roof of the tunnel. As a rule, this procedure is carried out under regional anaesthesia, i.e. only the arm is anaesthetized.
Intraoperative site of the
median nerve
After the operation, a wrist brace is fitted to be worn for 2 weeks, allowing the hand to be exercised several times a day. Stiches are removed after about 12-14 days. It can take 6-8 weeks before use of the hand is fully restored. During this period, the scar can remain somewhat painful. The success rate of CTS operations lies at more than 90%, with a recurrence of symptoms being extremely rare.