CARPAL TUNNEL SYNDROME
Reconstructive surgery:
This document has been conceived under the authority of the French Society of Plastic, Reconstructive and Aesthetic Surgery (SOFCPRE).
DEFINITION, AIM AND PRINCIPLES
Described in 1950 by Phalen, carpal tunnel syndrome is very common.
The carpal tunnel is a tunnel between the strong ligament of the palm of the hand, the anterior annular carpal ligament, and the bones of the radiocarpal joint.
The flexor tendons and the median nerve are involved in this canal at the wrist.
Carpal tunnel syndrome (CTS) is the consequence of compression of the median nerve by the anterior annular ligament or more rarely by synovitis or a compressive tumour (lipomas, angiomas, etc).
The first signs are characterized by tingling in the first three fingers, thumb, index finger, middle finger and half of the 4th finger on the side of the thumb.
A sensation of tingling and burning occurs readily at night or on waking in the morning. Later, it can appear pain in hand that can go up to the forearm, elbow and even shoulder.
Over time, may occur a loss of sensitivity, clumsiness and a deficit of mobility of the thumb, along with muscle wasting of the hand.
To confirm the diagnosis, an analysis of electrical nerves called electromyography is often practiced. This test is performed by a neurologist to record the quality of the passage of electric current in the median nerve. This examination may specify if the nerve damage is substantial and whether to intervene surgically or to perform an infiltration as a first step.
It can also detect a simultaneous compression of other nerve or a more proximal compression at the forearm, elbow or neck.
If the CTS is left evolve, the median nerve loses its function and the fingers lose their sensitivity making it impossible to collect the objects and the inability to perform certain movements of the thumb as a pick up a coin, for instance.
BEFORE THE OPERATION
In the early stages, medical treatment by infiltration of the carpal tunnel and the wearing of a rest splint at night may be considered.
However, with the evolution often surgery becomes necessary and the operation consist to sever the anterior annular ligament covering the carpal tunnel.
A pre-operative assessment is performed in accordance with the usual requirements.
The anaesthetist will be seen for consultation at the latest 48 hours before surgery.
No medication containing aspirin should be taken within 10 days prior to surgery.
Stop smoking is strongly recommended before surgery.
It is essential to fast (do not eat or drink) 6 hours before surgery.
TYPE OF ANAESTHESIA AND HOSPITAL STAY
Type of anaesthesia
Usually, the procedure is done under regional or local anaesthesia. A tranquilizer is sometimes associated with this anaesthesia.
Hospital stay
In general, the intervention is performed in "ambulatory", that is to say, with discharge on the same day after several hours of surveillance. The patient can then return to his home as long as his/her general condition permits it.
Nevertheless, for social, family or personal reasons, hospitalization may also be contemplated.
THE PROCEDURE
The procedure can be done with endoscopy, leaving one or two small scars, or open, with a larger scar in the palm of the hand.
AFTER THE OPERATION: POSTOPERATIVE CARE AND FOLLOW-UP
Healing is achieved in one week and dressings are necessary during this period.
Each surgeon has his/her treatment schedule that he/she proposes to the patient.
Usually, the reeducation is not necessary, sometimes, however, physiotherapy is proposed to accelerate the recovery, especially when the post-operative inflammatory phase is important.
Indeed, pain on the palm of the hand can last for several weeks, which worries some patients. Nevertheless, the tingling in the fingers disappears very quickly.
In severe cases, the recovery is slower..
Some patients never recover fully the sensitivity of the first three fingers of the hand because of the importance and long duration of the median nerve compression.
Hand washing is quickly possible after the 6th post-operative day.
The return to the activities is variably depending on the type of occupation and generally is recommended three weeks of convalescence for manual activities.
Driving is possible after the first week.
The recovery of force may take several weeks, for example, open a bottle, twist a baize, etc.
POSSIBLE COMPLICATIONS
The complications are of two types:
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The usual complications of any surgery:
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Post-operative infection
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Haematoma
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Inflammatory reaction with swelling, sweating, joint stiffness that can sometimes evolve into reflex sympathetic dystrophy.
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This latter complication requires early consultation with the surgeon for its treatment.
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Exceptionally, lesions of the median nerve have been described, necessitating a re-intervention that always leaves painful sequelae and incomplete recovery of sensitivity.
Finally, the reappearance of tingling in the fingers can be linked to a recurrence of carpal tunnel, which is exceptional. In this situation, consultation with the surgeon should be envisaged in order to look for another more proximal compression at the forearm, elbow or neck. Your surgeon is the most qualified to answer all your questions. Feel free to tell him.
All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors.
You can be assured that if you are operated on by a qualified Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary.
These are the facts that we wish to bring to your attention, to complement what you were told during the consultation.
Our advice is for you to keep this document and to read it and think it over carefully after your consultation.
Once you have done this you will perhaps have further queries, or require additional information.
We are at your disposal should you wish to ask questions during your next consultation, or by telephone, or even on the day of the operation, when we will meet in any case, before the anaesthesia.
"Copyright", © "All Rights Reserved" SOFCPRE, any reproduction, even partial, of these texts is prohibited without permission from the French Society of Plastic Reconstructive and Aesthetic Surgery. A copy or reproduction by any means whatsoever, including photocopying, photography, screen capture, copy, paste, recording or otherwise, constitutes an infringement punishable under the Act of March 11, 1957 on the protection of copyright.
Authorization for reproduction of March 10, 2009, for: MCEI (www.chirurgiens-plasticiens.info).
This factsheet has been designed under the auspices of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as a complement to your first consultation; to try to answer any questions you can ask yourself if you intend to use a surgical lipo-filling.
The purpose of this paper is to bring you all the information necessary and essential for you to make your decision with full knowledge of the facts. So is it advisable to read with the greatest attention.