Dr. João Paulo Sousa

Orthopaedic Surgeon
Coordinator 
of the Department

Carpal tunnel
Disabling
But easily solved

HPA Magazine 16

Carpal tunnel syndrome is one of the most common pathologies in the daily life of an Orthopaedic Surgeon. 
The symptoms of this disease are a tingling sensation and numbness in the hands, with a characteristically night and morning schedule. The patient wakes up with numb hands, or at a later stage, sleep is interrupted with numbness and pain in the hands. The first treatment involves placing night splints, preferably made to measure, which often prevent or postpone surgery.

Diagnosis is fundamentally reached by the specialist on observation.  Electromyography is only necessary in cases when there is doubt or for medico-legal reasons.
Surgery is indicated when conservative treatment fails.
The alarm signals, are when the lack of sensitivity becomes permanent meaning that surgery is urgent.  One thing is when the fibres of a nerve connect and disconnect, the hand is then normal for periods of time. On other occasions there is a change in sensitivity, and yet others when the nerve fibres no longer connect and which, if they remain disconnected for a long time, lose their ability to recover; irreversible injuries are created and the lack of sensitivity will be permanent and irrecoverable. 
Surgical treatment involves carrying out a simple surgical intervention, which can be performed under local anaesthesia, on an outpatient basis. This surgery consists of sectioning a ligament, the flexor retinaculum, which closes the carpal canal, in order to decompress the nerve and thus resolve the patient's complaints.
Recovery is quick, mobility and dexterity are not lost, and the patient is able to perform all activities that do not involve the use of force. Strength is the last function to be recovered. 
 

The patient leaves surgery with a large dressing that limits the use of his hand, however, on the second day after surgery this dressing is replaced with a smaller one that allows him to perform almost all daily activities. Patient should avoid getting the dressing wet until the 10th day after surgery, at which time the dressing is removed. The stitches fall off spontaneously.
The patient leaves surgery with a large dressing that limits the use of his hand, however, on the second day after surgery this dressing is replaced with a smaller one that allows him to perform almost all daily activities. Patient should avoid getting the dressing wet until the 10th day after surgery, at which time the dressing is removed. The stitches fall off spontaneously.
The patient is encouraged to perform active mobility exercises and fight oedema (swelling) by raising the hand.
When both hands are involved, bilateral surgery is encouraged. Patients do not always initially accept this idea. However, when questioned after the surgery, most consider it to have been a good option. It has the advantage of needing less time off work, is more economical and results in a faster recovery due to the need to use the hands.  
There is rarely a need for physiotherapy and relapse is infrequent.