Carpal tunnel syndrome

The carpal tunnel is situated between the carpal bone and the transverse carpal ligament. It contains the median nerve which provides sensation to the thumb, the index finger and the middle finger. The median nerve and nine tendons pass through this tunnel.

There is often no particular cause leading to the compression of the median nerve in the wrist, but it may be linked to a fracture, intense manual labour, a sport, endocrinological problems (diabetes, hypothyroidism, a lack of vitamin B6, obesity, etc.), pregnancy, breastfeeding, or any other hormonal change.


Carpal tunnel syndrome: symptoms and diagnosis

Carpal tunnel syndrome mostly affects adults, and often women between the ages of 40 and 50. People with the condition complain of tingling in the ends of the fingers, which wakes them up at night. This is known as nocturnal ‘acroparesthesia’.

Both hands are frequently affected simultaneously.

Patients can also suffer from ‘pins and needles’ during the day, which sometimes causes them to drop objects.

There may also be wrist pain which can spread to the elbow, and even the shoulder.

A clinical examination is essential to define the level of the condition.

An electromyography test is also necessary in order to assess the nerve’s electrical activity and thus confirm the diagnosis. Electrodes are inserted into the skin so that the impulses transmitted by the nerve can be measured.  The test results will allow the doctor to establish what stage the condition has reached and prescribe the best treatment.


Carpal tunnel syndrome: treatment and progression

Medical treatment

Medical treatment may be attempted before any other intervention. Treatment consists of modifying activities insofar as it is possible. The patient must wear a splint at night. This may be accompanied by injections.

Surgery

The operation consists of releasing a carpal tunnel under pressure. This is the most common intervention in hand surgery (5 % of the adult population).
It is done at a day clinic, usually under local anaesthetic, and only requires a small incision in the palm.

The dressing is changed the next day or two days later. A plaster isn’t necessary because the patient is encouraged to mobilise the fingers as soon as possible. This allows the patient to recover mobility thanks to voluntary muscle contraction.

Post-operative pain can be relieved with paracetamol (Dafalgon, Panadol, etc.).

The dressing must remain dry for about ten days.

Physiotherapy isn’t required if the fingers have been mobilised.

Pain at night will cease as of the first night.

Tingling during the day may continue depending on the length and extent of the compression of the carpal tunnel before the operation, hence the importance of taking action in good time.

Patients are recommended to take two to eight weeks off work, depending on their profession.