Introduction
In carpal tunnel syndrome, conservative therapy methods are usually not sufficient. If the symptoms are mild, however, surgery is not necessary immediately. Even in older patients with a low level of suffering and high-risk pre-existing conditions, surgery is not necessarily necessary.
This also applies to carpal tunnel syndrome during pregnancy, where special hormonal influences can only lead to a temporary carpal tunnel syndrome. The most common surgical method is open splitting of the carpal ligament. But arthroscopic splitting of the carpal ligament is also possible.
If performed correctly, both methods are equivalent. Certain requirements must be met for the arthroscopic method. Both surgical procedures are generally performed on an outpatient basis.
The aim of carpal tunnel syndrome surgery is to permanently relieve pressure on the median nerve, which is brought about by splitting the flexor-side carpal ligament (retinaculum flexorum). Although in most cases the operation is performed conventionally open, there are also arthroscopic techniques that allow the carpal ligament to be split. An operation should always be based on a reliable diagnosis.
For this, neurological evidence of carpal tunnel syndrome is necessary. The operation is performed by orthopedic surgeons, hand surgeons or neurosurgeons. In the course of cost reduction in the health care system, the operation is almost exclusively performed on an outpatient basis. An inpatient stay is also mostly not necessary.
Indication for surgery
In most cases, it is sufficient to treat carpal tunnel syndrome conservatively (i.e. not surgically but by preserving the tissue of the injured organ). This includes sparing the wrist region, wearing a splint at night and treatment with drugs to relieve pain and inhibit inflammation. and therapy of carpal tunnel syndrome If these therapeutic approaches do not result in an improvement of the symptoms, i.e. pain relief, recurrent sensitivity and return of strength in the thumb muscles, surgical treatment is indicated.
Furthermore, carpal tunnel syndrome surgery is advisable as soon as there is a risk of irreversible nerve damage (i.e. the healthy state of the nerve cannot be restored). This can be the result of acute compression of the nerve caused by an accident or inflammation. Indication for carpal tunnel syndrome surgery may also be the presence of an additional disease, such as diabetic polyneuropathy (=damage to many nerves (polyneuropathy), which is caused by diabetes mellitus.
The aim of the carpal tunnel syndrome surgery is to relieve the pain and eliminate the remaining symptoms. However, the success depends on the point in time at which the carpal tunnel syndrome surgery is performed; patients whose paresthesia and nerve damage is already far advanced may still have a sensitivity disorder. As with any surgical procedure, swelling after surgery can provoke pain.
A less typical pain is caused by a chronic neurological disorder called CRPS (Complex Reginal Pain Syndrome, also known as Sudeck’s Disease). The causes of this disease are still unknown. In any case, it is an irregular healing process after injuries, accidents or operations. Mostly hands, forearms, feet or lower legs are affected, so that this disease can also manifest itself after carpal tunnel syndrome surgery. In addition to the pain, the wrist is overheated, the skin is reddened and there is swelling, which in turn causes additional pain.
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