What is?
The median nerve is a structure that passes through the wrist under a thick ligament (annular ligament of the carpus) and that gives sensitivity to the fingers from the thumb to part of the annular. The only one that is left without that innervation is the little finger that is innervated by the ulnar nerve. In addition, it gives innervation for the mobility of some muscles of the hand.
Sometimes, this nerve can become trapped and develop the symptoms of paresthesias (corking) leading to loss of strength.
Carpal tunnel syndrome is the most frequent nerve compression syndrome in the population, reaching up to 10% of it. It is more frequent in women, manual workers and from 40-50 years.
What symptoms does that have?
El síndrome de túnel del carpo (STC) suele comenzar como adormecimiento o acorchamiento de los dedos pulgar, índice, corazón y anular. No siempre se duermen todos los dedos en fases iniciales.
It is common for patients who suffer from it to suffer these symptoms at night, becoming very uncomfortable and waking them up with the need to move their hand so that the symptomatology subsides.
As you progress over time, these symptoms will occur more frequently and performing daily activities. If the pathology progresses further, without treatment, it can cause those fingers to remain “asleep” permanently and affect muscles of the hand producing loss of strength of the hand.
Why is it produced?
La base de esta enfermedad es un atrapamiento del nervio mediano al pasar bajo el ligamento anular del carpo a la altura de la muñeca. Este ligamento puede engrosarse y pinzar el nervio dando lugar a los síntomas comentados.
This pathology can occur for multiple reasons that can be an overuse as in professions of great manual activity, repeated loads, repeated trauma or maintenance of positions.
It has been seen that it is somewhat more frequent in women and in endocrine-based pathologies such as thyroid diseases and pregnancies.
In summary, it can be produced by a sum of situations both specific to the individual (hormonal, endocrine or sex reasons) and by extrinsic factors (work).
How is it diagnosed?
El principal diagnóstico de esta enfermedad es clínico, es decir, la suma de los síntomas que comenta el paciente en la consulta y la exploración mediante una serie de maniobras concretas.
In addition, an electromyogram may be requested to assess the level of nerve involvement. The more involvement you have, the worse the prognosis of recovery that nerve will present.
How is it treated?
Como en muchas enfermedades, el tratamiento puede realizarse de manera conservadora o quirúrgica.
Initially, a conservative treatment can be performed based on splints for night use and neurotrophic drugs (vitamin complexes to improve the nerve) but that do not eliminate the compression produced by the nerve.
In many cases we recommend surgical treatment for the simplicity of the procedure, good results obtained and to avoid the progression of the pathology.
What is surgery?
La intervención es muy sencilla y consiste en una incisión pequeña de unos 2 cm en la región de la muñeca llegando directamente sobre el ligamento engrosado. Este se secciona, protegiendo el nervio, y se revisa posteriormente que no exista ninguna otra causa de compresión. Tras esto se lava, se sutura y se daría por finalizada la intervención.
The intervention is performed under local anesthesia to allow the patient to go home after it.
This intervention has an average duration of about 5-7 minutes.
This is the most definitive solution and the one that prevents in the vast majority of cases the progression of the pathology.
What is the postoperative period?
La cirugía se realiza con anestesia local y suele ser ambulatoria, es decir, no requiere pasar la noche en el hospital.
The patient leaves the operating room with the wrist bandaged but is allowed to move from the first moment. This bandage will be removed after the first cure and changed for a dressing.
Later you only have to have the wound clean and dry until the removal or fall of the stitches. The discharge time is short due to the type of intervention and the surgical technique used, varying, depending on patients, from one to three weeks
