Carpal tunnel syndrome - diagnosis and therapy

How to recognize a carpal tunnel syndrome?

In the typical complaints tingling, pain and declining muscle strength several tests are performed, which differentiate the carpal tunnel syndrome from other nerve damage. A positive Hoffmann-Tinel sign is when the tapping of the flexor region below the wrist causes electrifying pains. The Phalen sign is positive when greater flexion in the wrist for 60 seconds causes tingling and pain in the first three fingers. The radiograph reveals bony changes in the carpal, which may narrow the carpal tunnel.

Measure nerve conduction velocity

In addition, the nerve conduction velocity can be measured; In carpal tunnel syndrome, the measured values ​​of the peripheral median are typically altered compared to the opposite side and to other nerves.

But other illnesses can lead to pain, tingling and declining muscle strength or emotional loss: If it comes in the cervical spine to degenerative bony changes that constrict the nerve roots, especially the nerve root C6 / C7, then similar symptoms may occur. However, the other arm nerves are often affected and the symptoms are not limited to the thumb, index and middle finger and palms.

The ulnar sinus syndrome (sulcus ulnaris-syndron) does not damage the median nerve but the ulnar nerve. It runs inside the elbow near the bone and hurts when you hit the "musician's bone". If you often sit with your elbows on the table or write a lot with your forearm resting, it can cause nerve irritation. It is different than the medianus increasingly affected the little finger area.

What can be done against a carpal tunnel syndrome?

Unfortunately, no measures are known that actively counteract or prevent the development of a carpal tunnel syndrome. In the early stages, if the symptoms are only a short time, a conservative treatment can be tried. With a splint, the wrist is immobilized at night, and the narrowness of the carpal tunnel is not narrowed further by unconscious hand flexions during sleep. Cortisone injections into the carpal tunnel are also possible - however, it can lead to a nerve injury.

For longer-lasting complaints, the narrowness of the carpal tunnel is repaired surgically. During surgery, which is now offered in local anesthesia by many established hand surgeons, the flexor retinaculum is split, thus expanding the space for tendons and nerves. The OP is offered as an open and endoscopic variant, while the risk of nerve injury in the endoscopic variant is slightly larger, but the scar is much smaller.

After the operation, movement exercises are started quickly, heavier work by hand is allowed after six weeks at the earliest. The nerve recovers slowly, within a month the nerve fibers regenerate by about 10 millimeters. The symptoms go back over the course of months - even after half a year can still improve.

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