Zeljko Kojadinovic, MD- Neurosurgeon and Pain Specialist
Pressure on the median nerve in the hand (carpal tunnel syndrome) is caused by pressure on the median nerve in the middle of the root of the palm. The pressure on the nerve is mostly caused by the thickening of the transverse ligament which extends over the middle part of the palm (below the skin and above the median nerve). It is more common in women (especially during pregnancy), people with rheumatic diseases, those who firmly clench their fists or lean on their hands during work, and diabetics. However, often none of the above predisposing factors are present. It is not uncommon for it to occur in both hands at the same time. Carpal tunnel syndrome is present around the world in different countries (USA, Nigeria, Kenya, Tanzania, Germany, Japan, etc.).
The disease is manifested by pain that usually occurs at night. The pain starts from the root of the hand and spreads to the elbow. The thumb, index finger and middle finger are most often numb. Clumsiness and weakness of the hand, especially the thumb, occur. Atrophy of the muscles at the root of the thumb can be seen when compared to the opposite side. The diagnosis is made on the basis of an examination and an EMNG recording. It is often not a clear case and experience is needed to establish that the problems originate from this disease, and not, for example, from the cervical spine, or pressure on the median nerve in other places. In these unclear cases, it is important that the examination, diagnosis and treatment be performed by a neurosurgeon.
Treatment initially involves rest, analgesics, wearing an arm sling so as to avoiding hanging the fist. These so-called interventional non-operative methods in the treatment of carpal tunnel syndrome are very successful. During pregnancy, surgery is rarely indicated (because the cause is general swelling that will subside a few months after the operation). Many pregnant women have tingling and pain in different nerves at the same time.
If the pain is severe and lasts longer than a few months, and if significant nerve damage occurs (shown by examination and EMNG), surgical treatment is required. It consists of cutting a fibrous strip at the root of the palm that passes over the median nerve and presses it (flexor retinaculum, transverse carpal ligament). It can be attained by various small skin incisions. The scar is barely noticeable after a few months. Exercises can be started the day after the operation.
Part of the problem is immediately resolved by the operation. The pain is mostly reduced or even eliminated in a few days. Also, after a few days, numbness and weakness are partially reduced. Other symptoms improve after a few months, as it is necessary for the nerve fibers that were significantly damaged to grow back. Also, the more severe the nerve damage, the greater the chance that the nerve will not fully recover after the operation. However even then there is a significant improvement in over 90% of cases in terms of pain and over 50% of cases in terms of numbness and weakness. Nerves recover worse in the elderly, diabetics, alcoholics, and those who have other causes of polyneuropathy.
