Chirurgische Praxis Alstertal Heegbarg 14 22391 Hamburg Tel: +49 (0) 40 602 30 06
 

Carpal Tunnel Syndrome – numb fingers – fingers tingling – CTS

Hand Surgery and Surgical Practice Alstertal Hamburg Poppenbüttel – Tel: + 49- (0) 40- 602 30 06 Hand Surgeon Dr. Stefan Peters

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Schematische Darstellung der Anatomie im Bereich des Kardantunnels von beugeseitig

Schematic view of the carpal tunnel from flexor side of the wrist. (Mittelnerv= Median Nerve, Beugesehnen = Flexor tendons)

Constriction of the median nerve at the wrist. Causes tingling of the fingers, pain (which can spread up to the shoulder), loss of sensibility at the fingertips, clumsiness of the hand.
The carpal tunnel syndrome is the most common disease at the hand. In the Western world each one out of four is concerned. The median nerve runs deep in the hand in a bone channel (carpal tunnel) along with the flexor tendons. This channel / tunnel is closed and isolated to the surface with a strong ligament. It is believed that this band was necessary in the early evolution, when we were still 4-legged friends, to bear the bodyweight. Nowadays  we no longer walk  on all fours, but that band has remained and frequent causes problems . The tunnel is  typically created quite narrow by the nature, in addition after years of use the flexor tendons are thickening, it results in  no longer sufficient space which creates pressure on the nerve.

Occurrence of CTS  is  also typical  during pregnancy caused by the  water retention in the body, so also in the tunnel. In rare cases, compression of the Median nerve through a tumor or a fracture can occur.
Initially, you wake up at night because the fingers tingle (thumb, index, middle and 1/2 ring finger ), later the numbness and tingling happens over the daytime. It can cause pain, starting at the wrist, ascending to the shoulder. Tingling starts for example when working with a computer mouse, while cycling and swimming.

therapy

In  initial stage often nocturnal immobilisation in a wrist splint helps. The splint  keeps  the wrist in a  “nerve friendly” position. Disadvantage: the effect of the splint vanishes almost after half a year. In pregnancy the CTS  frequently  minimizes after birth spontaneously. Some report a positive effect of local cortisone injection, which we do not recommend. Finally, it is the narrow tunnel that is causing the problems,this is not a disease and has no chance to get cured spontaneously.  Therefore, it is usually wise to fix the problem surgically. The stiff tunnel roof (ligamentum carpi transverse) has to be eliminated.

Operating room

In local anesthesia decompression of the Median nerve. This is done through a small incision in the palm of the hand (see here the typical approach). The ligament (transverse carpal ligament) will be complete opened under view of the nerve. Finally, the nerve is carefully inspected and checked for complete decompression. Duration less than 10 minutes, 99% permanent cure. Therefore,the risk of Nerve compression reoccurrence is one percent. (Reason: Adhesions and unusual strong internal scars).

However, an operative repair, when reoccurrence happens is not dangerous or difficult. I will be done in local anesthesia, the procedure needs some more minutes and the incision is about 4-5cm long.

What’s next

splint for a day. Little pain, you will be supplied with pain relievers. Hand can be used immediately after operation almost normal.  If needed, sick leave 2 to 3 weeks, no car use for 2 to 3 days after the operation.

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 Dear Patient, this page is made to inform you and provides essential information about medical issues.

We have published this page in good faith and based on our years of experience and  latest scientific findings.

Of course, a guarantee for  correctness and completeness can not be given in the rapidly-developing field of medicine. Even other doctors may disagree. 

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  • Dr. med. Stefan Peters
    Handsurgeon
    Trauma Surgery
    General Surgeon

    Dr. med. Stephan Berg
    Orthopedics
    General Surgeon
    Trauma Surgery

  • Hours of Service

    Monday
    8:30–11:30 + 16:00–17:30
    Tuesday
    8:30–11:30 + 16:00–17:30
    Wednesday
    8:30–11:30
    Thursday
    8:30–11:30 + 16:00–17:30
    Friday
    8:30–11:30

    fresh accidents
    (the same day):

    Monday to Friday 8:00–18:00 clock

    … and by appointment.

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