Causes, Symptoms, and Necessity of Carpal Tunnel Surgeries

Causes of Carpal Tunnel Syndrome

If you follow our Instagram or Facebook page, you’ve already seen this week’s topic: problems in the carpal tunnel and the associated carpal tunnel surgery.
Carpal Tunnel Syndrome (CTS) occurs due to compression of the median nerve in the carpal tunnel of the wrist. The carpal tunnel is a narrow passage in the wrist through which tendons and the median nerve pass. Possible causes of narrowing or swelling in the carpal tunnel include:

  • Overuse and Repetitive Movements: Frequent repetitive movements of the wrist, as seen in certain professions or activities, can promote carpal tunnel syndrome.
  • Inflammatory Conditions: Diseases like rheumatoid arthritis can lead to swelling of the tendons and surrounding tissue.
  • Hormonal Changes: Pregnancy, menopause, and other hormonal changes can increase the risk.
  • Injuries: Wrist fractures or other trauma can narrow the carpal tunnel.
  • Hereditary Factors: A genetic predisposition can also play a role, as some people naturally have a narrower carpal tunnel.

Symptoms of Carpal Tunnel Syndrome

The symptoms of CTS typically develop gradually and include:

  1. Numbness and Tingling: These sensations often occur in the fingers (thumb, index, middle, and ring fingers) and can radiate up the arm.
  2. Pain: Pain can occur in the wrist, hand, or forearm and may be worse at night.
  3. Weakness: Affected individuals may have difficulty gripping small objects or using their hand, and there may be a loss of fine motor skills.
  4. Swelling: Some patients report a feeling of swelling in the fingers, even though there may be no visible swelling.

Necessity of Carpal Tunnel Surgery

A carpal tunnel surgery is considered when conservative treatments like splints, medications, or corticosteroid injections have not been successful. The decision for surgery is based on:

  1. Severity and Duration of Symptoms**: Surgery is recommended for persistent or severe symptoms that affect sleep or daily activities.
  2. Nerve Conduction Studies: These tests can determine the severity of nerve compression.
  3. Failure of Conservative Therapies: If non-surgical measures do not provide adequate relief, surgery may be necessary to prevent permanent nerve damage.

Carpal tunnel surgery, known as carpal tunnel release, can be performed through open surgery or endoscopically. Both methods aim to cut the carpal ligament to relieve pressure on the median nerve.

Physiotherapy after Carpal Tunnel Surgery

Goals of Physiotherapy

After carpal tunnel surgery, physiotherapy is crucial for restoring hand function. The main goals of physiotherapy are:

  • Pain Relief: Reducing postoperative pain and swelling.
  • Improvement of Mobility: Restoring full range of motion in the wrist and fingers as much as possible.
  • Strength Building: Strengthening the muscles of the hand and forearm.
  • Nerve Mobilization: Improving nerve conductivity and sensitivity.
  • Functional Restoration: Supporting the resumption of daily activities and occupational tasks.

Typical Physiotherapeutic Measures

  • Manual Therapy: Techniques for mobilizing the wrist and affected tendons and nerves.
  • Stretching Exercises: Exercises to improve flexibility and mobility of the hand and wrist muscles.
  • Strengthening Exercises: Specific exercises to strengthen the muscles of the forearm and hand.
  • Nerve Mobilization Techniques: Exercises to improve the gliding ability of the median nerve in the carpal tunnel.
  • Scar Massage: Techniques to improve healing and mobility of scar tissue.
  • Ergonomic Advice: Guidance to avoid overstrain and improve working conditions.
  • Manual Lymphatic Drainage: Techniques to reduce postoperative swelling and edema through gentle, rhythmic massage movements that promote lymph fluid drainage.

Course of Physiotherapy

Physiotherapy after carpal tunnel surgery occurs in several phase:

  1. Acute Phase (0-2 weeks):
    – Focus on pain control and swelling reduction.
    – Gentle mobility exercises for fingers and wrist.
    – Application of cold therapy for pain relief.
    – Manual lymphatic drainage to reduce swelling and edema.
  2. Early Rehabilitation Phase (2-6 weeks):
    – Introduction of stretching and strengthening exercises.
    – Start of nerve mobilization techniques.
    – Continuation of manual therapy to improve mobility.
    – Manual lymphatic drainage to support healing and reduce swelling.
  3. Late Rehabilitation Phase (6 weeks and beyond):
    – Intensification of strengthening exercises.
    – Increase in functional exercises to resume daily and occupational activities.
    – Ergonomic adjustments and training to prevent future overstrain.

Success Prospects of Physiotherapy

The combination of surgery and targeted physiotherapy generally leads to significant improvement in symptoms and hand function. Early and consistent physiotherapy treatment can shorten healing time, reduce the risk of complications, and accelerate the return to normal activities.

Risk and Course of Potential CRPS (Complex Regional Pain Syndrome)

What is CRPS?

Complex Regional Pain Syndrome (CRPS), also known as Sudeck’s atrophy or reflex sympathetic dystrophy, is a chronic pain condition that often occurs after injuries or surgeries on the extremities. CRPS is characterized by persistent pain that exceeds what would be expected from the original injury or surgery.

Causes and Risk Factors

The exact cause of CRPS is not fully understood, but it is believed to be caused by an abnormal response of the nervous system to injuries or surgeries. Possible risk factors for developing CRPS after carpal tunnel surgery include:

  • Nerve Injuries: Injuries to the median nerve or other nerves during surgery.
  • Severe Postoperative Pain: Intense and persistent pain after surgery.
  • Immobilization: Prolonged immobilization of the wrist or hand.
  • Symptoms of CRPS

The symptoms of CRPS include:

  • Persistent, Intense Pain: Pain that is out of proportion to the original injury or surgery.
  • Swelling: Persistent swelling in the affected area.
  • Changes in Skin Color and Temperature: Skin may turn red, blue, or pale and feel warmer or colder than the surrounding area.
  • Excessive Sweating: Excessive sweating in the affected area.
  • Movement Restrictions: Stiffness and restricted movement of the affected limbs.
  • Muscle Atrophy: Loss of muscle mass due to reduced use.

Course and Prognosis of CRPS

The course of CRPS can vary, but it is often divided into three phases:

  1. Acute Phase (0-3 months): Intense pain and swelling, skin changes, and increased sensitivity.
  2. Dystrophic Phase (3-12 months): Persistent pain, intensified skin and tissue changes, muscle atrophy, and movement restrictions.
  3. Atrophic Phase (12 months and beyond): Irreversible changes in skin and tissue, persistent pain, and significant movement restrictions.

The prognosis for CRPS is variable. Early diagnosis and treatment are crucial to achieve the best results and minimize the risk of long-term damage.

Physiotherapy for CRPS

Physiotherapy plays a vital role in the treatment of CRPS. The goals of physiotherapy for CRPS include:

  • Pain Control: Reducing pain through various therapy methods.
  • Restoration of Mobility: Improving the mobility of the affected limbs.
  • Strength Building: Strengthening the muscles to support function.
  • Promotion of Blood Circulation: Improving blood flow in the affected area.
  • Reduction of Edema: Reducing swelling and edema.

Typical Physiotherapeutic Measures for CRPS

  • Gentle Mobilization: Careful movement exercises to improve mobility.
  • Desensitization Techniques: Methods to reduce hypersensitivity.
  • Strengthening Exercises: Exercises to strengthen the affected muscles.
  • Mirror Therapy: A technique that tricks the brain into perceiving the affected limb as healthy to relieve pain.
  • Manual Lymphatic Drainage: Gentle, rhythmic massage movements to reduce swelling and edema by promoting lymph drainage.
  • Thermal Applications: Alternating applications of heat and cold to relieve pain and swelling.

The treatment of carpal tunnel syndrome and CRPS requires a careful and comprehensive approach. Physiotherapy plays a crucial role in the postoperative phase by relieving pain, improving mobility, and supporting the healing process. In the treatment of CRPS, early and consistent application of physiotherapeutic measures is essential to achieve the best results and avoid long-term complications.