Orthopedic conditions explained in simple terms

Here you will find answers to frequently asked questions and information on typical clinical pictures.

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Also known medically as carpal tunnel syndrome (CTS), it is a chronic compression injury of the median nerve in the wrist. The nerve, along with other anatomical structures, is located in a narrow bony canal bordered by a ligament. The discrepancy between the canal’s volume and its contents leads to nerve compression. The extent of nerve damage depends primarily on the severity and duration of the compression. Between 3 and 5% of the population are affected. The female-to-male ratio is 2:1. A familial predisposition is observed.

… Possible causes

Malunited forearm fracture (distal radius fracture), dislocation of a carpal bone, wrist osteoarthritis with bone spur formation, rheumatic diseases of the joints and tendon sheaths, traumatic injuries (bruising, scarring, infection, bone fragments), tumors (wrist ganglion, neuromas), abnormal muscle development, hormonal changes during pregnancy, gigantism (acromegaly), metabolic disorders (diabetes, gout), thyroid dysfunction.

Symptoms

Primarily nocturnal sensory disturbances (“…my fingers go numb”), pain in the thumb, index and middle fingers, pain when holding objects, clumsiness and weakness of the hand, pain radiating into the forearm, difficulty with fine motor skills and pincer grasping (e.g., sewing, buttoning and unbuttoning, picking up and gripping objects), atrophy of the thenar muscles.

Therapy
Reduction and avoidance of overuse and improper strain in daily life, work, and sports. Further measures include: immobilization of the wrist in a forearm splint, wearing a wrist brace, injection of corticosteroids into the carpal tunnel to reduce swelling of the connective tissue, and acupuncture. During pregnancy, it is recommended to wait and see, depending on the symptoms and remaining duration of the pregnancy.

Prognosis
In most cases, surgery is necessary (resection of the flexor retinaculum or neurolysis of the median nerve). Open or endoscopic procedures are generally used. Pain and numbness usually subside rapidly after surgery. Muscle atrophy has a poorer prognosis. Relapses are rare.