What is Carpal tunnel syndrome?

Carpal tunnel syndrome is the compression of the median nerve in the wrist.

The median nerve is one of the main nerves of the hand. It goes through the wrist at the level of a bony canal formed by the carpal bones. This canal is covered by a ligament called the retinaculum (transverse carpal ligament). In some patients, the median nerve can be compressed in the carpal tunnel, causing numbness in the first three fingers of the hand (thumb, index and middle fingers) and sometimes weakness in some muscles of the hand. These symptoms can be extremely uncomfortable or painful, cause you to wake up at night, and have a significant impact on your quality of life.

Simple, painless surgery can be performed to sever the retinaculum of the carpus to decompress the nerve and improve the symptoms.

What are the symptoms of carpal tunnel syndrome?

The Pain and discomfort of carpal tunnel syndrome typically wakes you up at night. It can also cause you to lose feeling in your hands and also causes hand pain and weakness during the day; preventing so many people from performing daily activities in a comfortable way.

Here are main symptoms of carpal tunnel syndrome:

  • Numbness and tingling in the thumb, index, and middle fingers
  • Pain and burning in the hand and wrist that may radiate up the arm to the elbow
  • Decreased sensation and weakness in the hand with diminished grip strength
  • Worsening of symptoms at night

What are the procedure techniques and scars

An incision is made along the band in the finger. Dr Boudana uses the incision to divide and remove the thickened connective tissue, allowing the finger to straighten, the scar will be made as a zigzag to prevent the scar tightening.
Following the procedure, a light compression dressing is applied and will be removed on the second day after surgery to be replaced by a light wound dressing.

  • Anaesthesia:
    Local (without tourniquet)
  • Duration:
    1 hour
  • Pain level:
    4/10
  • Recovery time:
    2 to 6 weeks
  • Resumption of physical activities:
    6 weeks

Procedure details

The main complaints of the patient and a careful physical examination are the most important components of making a diagnosis, but sometimes extra tests are required. These may include an X-ray of the wrist, particularly if there has been a history of a fracture or other trauma to the wrist, and nerve conduction studies, which look at the electrical qualities of the median nerve; as nerve damage progresses the performance of the nerve decreases on nerve conduction studies.

Aponevrectomy consists of removing only the part of the palmar aponeurosis that causes the formation of nodules or tightened cords. It is impossible to remove the entire aponeurosis.

After disinfection of the hand, local anaesthesia is performed on the palm area to be treated.

Then the removal of the nodules and cords is carried out. Particular attention must be paid to the preservation of the fingers’ blood vessels and nerves, whose diameters are in the order of millimetres. Sometimes, because of considerable contracture, a skin graft must be performed to allow the fingers to be extended. This should be discussed during the pre-operative consultation with Dr. Boudana.

After the surgery, you will receive a personalized follow-up. Our nurses will also be available and will perform all dressing changes at our clinic.

You will be given a postoperative instruction sheet when you are discharged as well as a prescription for pain medication.

Results

Considerable work with the hand therapists is necessary to get the optimum results. Visits with the hand therapist will initially be weekly, then after 6-8 weeks will usually be second weekly. The biggest hurdle after surgery is regaining full flexion of the fingers, and a lot of work is required to achieve this.

It is important to understand that recurrences are frequent because it is a genetic disease. The aim of surgery is to treat lesions related to the current progression of the disease, but surgery does not cure Dupuytren’s contracture. It can remain active after the operation causing other similar lesions in the treated area and even more so in the non-operated areas.

Ready for get rid of your hand pain?

Schedule your personal or virtual consultation with Dr. David Boudana.

During your consultation, Dr. Boudana will take the time to address your specific goals and to discuss your treatment options. He will determine if the Dupuytren’s contracture surgery is right for you and review the results that can be realistically achieved.