Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a condition that can become quite painful and may significantly affect hand strength and dexterity. In most cases, it is associated with repetitive movements and tasks performed throughout the day, particularly those involving prolonged use of the hands and wrists.

Carpal tunnel decompression is an easy operation that lasts 10 to 15 minutes. The stay in the hospital in no more than 3 hours overall.

Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand. It occurs when one of the main nerves of the hand—specifically the median nerve—is compressed at the level of the wrist.

The carpal tunnel is a narrow passageway located in the wrist, formed by small bones known as the “carpal” bones.

The median nerve is one of the primary nerves of the hand. It travels along the arm, passing sequentially through the elbow, the forearm, and then through the carpal tunnel. From there, it reaches the palm and fingers, where it branches into multiple smaller nerves.

In most patients, carpal tunnel syndrome progressively worsens over time. If not treated effectively, it may lead to permanent hand dysfunction, with symptoms such as loss of sensation in the fingers, persistent numbness, and significant weakness.

Compression of the median nerve at the wrist is usually caused by repetitive movements performed on a daily basis, such as frequent use of computers or mobile phones.

However, most cases of carpal tunnel syndrome result from a combination of factors. Studies show that women and older adults are more likely to develop the condition compared to the general population.

The main risk factors for carpal tunnel syndrome include:

• Heredity. This is perhaps the most significant factor and should always be mentioned during medical history taking.
• Repetitive wrist movements. Activities such as writing, typing on a keyboard, or using a mobile phone increase pressure in the wrist area, contributing to the development of the syndrome.
• Pregnancy. Hormonal changes during pregnancy may cause swelling in the wrist. Symptoms usually resolve after childbirth; however, if they persist, surgical treatment may be required.
• Various medical conditions. Less commonly, carpal tunnel syndrome may be associated with underlying medical conditions such as diabetes mellitus, rheumatoid arthritis, and hypothyroidism.

The main symptoms of carpal tunnel syndrome include:

• Numbness
• Tingling
• Burning sensation and pain (mainly in the thumb and index finger)
• Weakness
• Clumsiness or even loss of proprioception in the hand, resulting in difficulty performing fine motor tasks such as buttoning clothes

Symptoms usually begin gradually, initially creating the sensation that they come and go. This intermittent nature may mislead patients at first, causing them to ignore the symptoms. However, as the condition progresses, the symptoms become more frequent and last longer in duration.

Carpal tunnel syndrome usually worsens over time if the patient does not consult the appropriate specialist and follow a proper treatment plan.

Early evaluation and diagnosis play a crucial role in the progression of the condition. With appropriate medical care, its course can be slowed down or even completely halted, allowing the patient to regain strength and mobility in the hand.

The diagnosis of carpal tunnel syndrome may range from a simple clinical examination to a series of painless diagnostic tests, such as:

• Electrophysiological studies, including nerve conduction studies and electromyography (EMG). These tests provide valuable information about the function of the median nerve and help determine the degree of compression it is undergoing.
• Wrist ultrasound, which helps evaluate the median nerve and visualize the exact points where compression occurs.
• X-ray, performed to rule out other possible causes of wrist pain, such as arthritis, ligament injuries, or a potential fracture.
• Magnetic resonance imaging (MRI), which provides superior visualization of soft tissues compared to a standard X-ray. It is used to exclude other causes or to detect tissue abnormalities affecting the median nerve.

The first line of treatment is conservative and includes rest, specific wrist exercises, the use of a splint, and/or medication. Avoiding all activities that cause pain and fatigue in the hand should be taken seriously by the patient, so that the treating physician can properly evaluate the condition before and after treatment. If such activities cannot be completely avoided, it is important to take frequent breaks of sufficient duration to allow the hand to rest. However, it has been shown that conservative management (splints, pain relievers, corticosteroid injections) does not provide long-term benefit. It mainly offers temporary symptom relief and is generally effective only in the early stages of the condition.

If conservative treatment fails and symptoms persist, carpal tunnel syndrome can be effectively treated with surgery. The primary goal of the surgical procedure is the decompression of the median nerve.

Carpal tunnel exercises on their own are unlikely to relieve the most common symptoms of the condition, such as pain and numbness. However, exercises are significantly more effective when combined with other forms of treatment, as well as lifestyle modifications (particularly avoiding activities that aggravate the condition). In addition, wrist splints can provide substantial support and symptom relief in cases of mild to moderate carpal tunnel syndrome.

The definitive treatment for carpal tunnel syndrome has traditionally been surgical decompression of the median nerve, performed either through an open or endoscopic technique. The procedure is carried out under local anesthesia and does not require hospitalization. The patient can return home the same day and resume daily activities relatively quickly, usually within approximately two weeks.

Decompression is achieved by making an incision of 3 cm in the transverse carpal ligament, thereby increasing the capacity of the carpal tunnel and improving blood flow to the nerve. This restores its normal function.

During the first few days after surgery, it is normal to experience mild pain, some swelling, and stiffness in the broader wrist area. Mild pain in the palm may last from several weeks to a few months; however, it gradually and noticeably decreases over time. If the sensation of stiffness and generalized weakness persists for more than two months, your physician may recommend physical therapy to optimize the results. In more severe cases, recovery may understandably be somewhat slower, although this does not mean that improvement will not occur.

Immediately after the procedure, patients are encouraged to elevate the hand and move their fingers to help reduce swelling and prevent stiffness in the area. Regular movement ensures a shorter healing period and, consequently, a faster recovery. Sutures are typically removed approximately two weeks after the completion of the surgery. For a certain period, weight-bearing activities involving the operated hand should be avoided.

Nighttime symptoms of the syndrome, such as hand numbness during sleep, significantly improve for most patients within approximately the first week after surgery.

The cost of the procedure is generally quite affordable; however, it varies depending on the severity of each case and the selected treatment plan. Dr. K. Dretakis and his highly trained team will guide you in choosing the most appropriate treatment method, based on your personal expectations and medical needs. To receive detailed information regarding the exact cost, we recommend that you contact us directly.