Treatment of carpal tunnel syndrome (CTS) abroad
Carpal tunnel syndrome (repetitive stress injury) is a pathological process that often requires surgical intervention. CTS occurs three times more often among women than men. Majority cases are registered between 40 – 60 years of age. Incidence of this illness in different countries varies from 1,5% to 3%.
Causes of CTS
Carpal tunnel or canal is an anatomical structure in the form of a hole in the wrist bones area. Tendons of the fingers flexor muscles, as well as the median nerve pass through it. CTS develops when it narrows, causing compression of the median nerve and vessels with the development of appropriate clinical symptoms.
Pathological process is determined by several factors including:
- Genetic predisposition is one of the key risk factors
- Changes in the female endocrine profile as a result of pregnancy or menopause (age related decrease in the sex glands function) that lead to the accumulation of fluid in the ligaments of the carpal tunnel accompanied by swelling and narrowing of the lumen
- Age over 50 years old
- Wrist injuries in the medical history when the integrity of bone structures and ligaments was compromised
- Alcohol addiction leads to the damaged blood flow in the wrist tissues
- Systemic autoimmune pathology accompanied by the production of antibodies against own connective tissue (rheumatism, rheumatoid arthritis)
- Constant pressure on the wrist joints as a result of certain occupation (probability of CTS is much higher among programmers, pianists, milkmaids)
- Pathology of the endocrine system, in particular diabetes mellitus, hyperthyroidism (increased functional activity of the thyroid gland)
- Development of the oncological process in structures and tissues of the carpal canal area (benign or malignant tumor, cysts)
It is obligatory to find out provoking factors of the disease in the modern German hospitals which helps to choose the most effective treatment.
Symptoms of the CTS
Several characteristic symptoms point at the possible development of CTS:
- Numbness (paresthesia) of the skin in the palm, large, index and middle finger area
- Unpleasant tingling sensations of the hand skin, which usually intensify at night
- Periodic appearance of discomfort in the fingers in the form of “piercing” or “electric shock”, more often against the background of the pressure on the wrist and hand joints
- Decreased muscle strength when flexing fingers
The severity of symptoms decreases when arm position changes, but it increases back when the hand is held for a long time in one position under a pressure. Clinical manifestations of CTS are unstable at the initial stage of the disease, but as it progresses, they occur systematically.
Diagnostics of CTS
Objective diagnostics of the CTS put the goal to define the severity of this anatomical formation narrowing as well as the degree of compression of median nerve fibers.
A doctor orders several diagnostic techniques, which include:
- Radiography, computer tomography or magnetic resonance imaging for the visualization of tissues, ligaments and bony structures of the wrist area
- Rheovasography is a functional study of the blood flow in the tissues of the wrist and hand, which allows differentiatingviolation of the blood flow, resulting in a symptom similar to the CTS
- Neuromyography is the definition of the functional state of nerve stems and muscles
The choice of diagnostic tactics is determined by the clinical course of the disease, as well as by the diagnostic capabilities of the hospital.
Treatment of CTS abroad
CTS treatment is comprehensive and includes conservative measures as well as surgical intervention.
Conservative therapy is aimed at the removal of trigger factors that cause pathological process. Next steps are used for achieving this goal:
- Exercise therapy
- Lifestylechanges (changeofoccupation)
Surgery is radical in this case. There are several operations done to restore the normal lumen of carpal canal and anatomic correlation of its structures:
- Open surgery is performed through the skin incision in the wrist area to gain access to the carpal tunnel. Then a surgeon does plastic with suturing
- Endoscopic dissection of carpal ligaments is a less traumatic surgery, which allows for rapid functional restoration of the limb
Specialists in German hospitals give preference to the endoscopic dissection of carpal canal on an outpatient basis that doesn’t need long hospitalization.
Benefits of such surgery are:
- No small incisions and short rehabilitation period
- Effectiveness is the same as with an open surgery
- Reduced blood loss and risk of complications
- Better aesthetic effect
Prognosis for CTS
33% cases of CTS resolve by themselves without any treatment. Favorable prognosis is characteristic if a patient is young or middle-aged; pathology is a result of pregnancy or hormonal changes and responds to correction.
Lack of timely surgical treatment can lead to an irreversible damage to the median nerve in elderly people. As a result, muscle weakness and hand numbness can develop and does not disappear even after the surgery.
Prognosis is favorable after surgical treatment. If it is done in a timely manner, and the integrity of the nerve is preserved, the symptoms completely disappear. Recurrence after surgery is very rare.
Complete restoration of the wrist functional activity varies from one month to six months. The terms of rehabilitation depend on the degree of carpal canal narrowing, the method of surgical treatment, and the age of the patient.