Carpal Tunnel Syndrome is the most common nerve compression disorder encountered in Orthopedic Clinics. The cable (median nerve), which comes out from between the neck vertebrae and goes to the first three fingers of the hand and the outer half of the 4th finger, may get stuck in the canal called the carpal tunnel as it passes through the wrist. As the pressure in the canal increases after compression, it can cause both movement and sensory deficits in the areas where the nerve reaches. . These may include numbness in the hands and fingertips, night pains, and weakness in grip.
CARPAL TUNNEL SYNDROME TREATMENT
The initial treatment for Carpal Tunnel Syndrome is non-surgical, that is, conservative treatment. In this treatment, if the patient's complaints and examination findings are mild, the use of a wrist splint, activity regulation and, in some cases, injections are performed. The treatment for moderate and severe carpal tunnel syndrome is surgery. The aim is to reduce the pressure inside the canal by opening the roof of the carpal tunnel longitudinally, where the nerve gets stuck while passing through it. Surgery methods are open surgery, partial open surgery, and endoscopic, which can be considered a form of closed surgery.
Possible complications of carpal tunnel surgery; Injury of the median nerve during surgery, formation of painful swellings called neuroma at the ends of the injured nerve, wound site problems and inadequate tunnel release. The most common cause of secondary carpal tunnel release surgery is insufficient release. Other reasons for the recurrence of the disease include inflammation of the tendons covering the fingers at the wrist level, scar tissue putting pressure on the nerve, formation of a space-occupying mass within the carpal tunnel, and stretching of the nerve after surgery. . Having diabetes, hypertension and rheumatic diseases are risk factors for recurrence of the disease.
DIAGNOSIS IN RECURRENT CARPAL TUNNEL SYNDROME
Complaints of numbness, loss of sensation, and pain that increases especially at night, which are seen in the first episode of the disease, recur. In severe cases, a decrease in squeezing strength and wasting of the hand muscles may occur. EMG used for nerve conduction measurement, primary nerve It is not as valuable as diagnosing r compression. Because even with good treatment, EMG findings return to normal only in 6 months. MRI and Ultrasound are used to examine the presence of a mass occupying space in the canal and the continuity of the nerve. Despite all these examination methods, the most important diagnostic method is the patient's description of electric shock when the nerve is touched with the fingertip in the damaged area.
TREATMENT FOR RECURRENT CARPAL TUNNEL SYNDROME
Treatment is surgery. The previous surgery area is opened wider and the possible damage to the nerve, the presence of painful nerve ending thickenings called neuromas, and whether the canal has been completely opened and loosened are examined. If there is an incision on the nerve, repair is made using microsurgical methods. Neuromas are cleared. If the nerve is cut and its ends cannot be joined, repair is made by placing the nerve taken from the leg in the form of a bridge. A vascular fatty tissue coil is made from the surrounding tissues to provide a slippery and moist environment for the median nerve, which is subjected to surgical intervention again. In the postoperative period, a cast is applied to the wrist for 2-4 weeks.
Read: 0
