The treatment of carpal tunnel syndrome has as its aim to reduce the pressure on the median nerve and prevent the damage from becoming irreversible with the passing of time. For this reason, it must be treated early once it has been diagnosed.
Modify manual activities. That trigger the compression of the median nerve, since its presentation is associated with repetitive manipulation activities.
Change working environment. And adopt ergonomic measures like special keyboards or wrist supports when the computer is used in order to avoid flexor and extensor forced postures.
Use splints. In order to maintain the wrist in a neutral position during the night and in short periods during work, if possible.
Rehabilitation. Perform a rehabilitation treatment where the application of physical agents and different types of exercise are combined.
Do muscle stretching and strengthening exercises at wrist level. They aim to alleviate the pain and improve mobility of the wrist.
Electrotherapy. There are different types of currents, such as ultrasounds, which help to reduce the pain, that is to say, they have an analgesic and anti-inflammatory action.
Corticosteroid injections, with or without local anaesthetic, in the carpal tunnel. A maximum of 3 injections is recommended, with an interval of 2-3 months between them. They can alleviate the symptoms and improve nerve conduction. The corticosteroids can also be applied using electric currents (iontophoresis).
The surgical treatment of carpal tunnel syndrome consists of the resection of the anterior transverse carpal ligament. Two types of technique are used: open surgery and endoscopic surgery.
Open Surgery. An incision of approximately 4 cm is made in the palm of the hand following the axis of the fourth metacarpal, thus avoiding injury to the sensitive palmar branch of the median nerve. An incision is then made in the subcutaneous cell tissue until the transverse ligament, which is sectioned longitudinally by its cubital edge. This is the preferred technique in our centre, since it allows us to visualise all the structures in a region where anatomical variations are not uncommon, and also to add surgical gestures like freeing the adherences of the median nerve to the annular ligament or the taking of a synovial biopsy.
Endoscopic Surgery. The incision is made in the flexor fold of the wrist. The device inserted through this, enables the deep side of the ligament to be seen as well as its resection. The comparative studies carried out show serious complications with the endoscopic method such as the resection of the median nerve, of the artery or the ulnar nerve and also a greater number of re-interventions versus scarcely demonstrated advantages. In our opinion, we consider the open technique limited to 3-4 cm in the palm of the hand is the best option.
Complications of surgical treatment
The most common complications are pain in the wound (25% of patients), which persists for 3 months and can re-appear in 7% of cases. In the cases of second surgery, the results are less satisfactory despite the different techniques having been developed to improve the outcomes.
Post Operative Period
After the surgery a compressed bandage is placed in order to partially immobilise the wrist so that the patient can move the fingers. The fact of moving the fingers immediately after the surgery favours the venous return and avoids inflammation of the arm. The stitches are removed 8-14 days after the surgery, and normal activities may be performed gradually.
Care after the surgery
When showering, they have to put plastic over the bandage so as not to wet it.
To sleep, it is recommended to place the arm on a pillow to help blood circulation.
Do not carry weights in the operated hand for three weeks.