סינדרום התעלה הקרפלית

Carpal tunnel syndrome (CTS) results from pressure on the median nerve in the palm that results from thickening of the ligament at the base of the hand. The median nerve is the central nerve in the palm and its job is to transmit the sensation from the fingers and pass commands to some of the small muscles in the palm. The median nerve originates from the roots located in the neck. When the nerve reaches the palm area, it passes through a narrow area called the carpal canal. The carpal canal is formed by the transverse ligament and forms a roof over the bones of the wrist. In this way, a tunnel is created in which the nine tendons of the wrist (two for each finger and one for the thumb) pass through as well as the median nerve. When a thickening of the ligament is created or something fills the space of the canal and increases the pressure on the nerve, carpal tunnel syndrome is created.

What causes Carpal Tunnel Syndrome (CTS)?

Carpal tunnel syndrome can happen acutely after a fracture of the palm, due to significant wrist injury or whatever causes the pressure within the canal to rise.

 A number of medical conditions can be associated with carpal tunnel syndrome such as tendinitis, diabetes, hypothyroidism, and even tumor within the canal. Despite all the above risk factors, in most cases the cause of the syndrome remains unknown.

How does carpal tunnel syndrome manifest?

Carpal tunnel syndrome is characterized by a palpation of the palm that can be accompanied by a burning sensation and even pain in one or more of the fingers. The pain can even reach the neck and easily to the forearm and arm. The pain often wakes from sleep and the person suffering from carpal tunnel syndrome often wakes up in the morning with drowsiness in the hands and sometimes with a tingling of the fingers. It is not uncommon to hear a story in which the patient wakes up and needs to shakethe hands to relieve the symptoms.

What is the natural course of the disease?

Carpal tunnel syndrome is characterized by mild initial cycles - ie, aggravated exacerbation and relief (this is why alternative therapies and so on "manage" to treat the syndrome), but as the years pass, the syndrome and symptoms (pain, loss of grip of delicate things) worsen. It worsens and the later the syndrome is treated, the smaller the chances of improvement and rehabilitation of the nerve.

Syndrome sufferers will initially complain of nocturnal tingling and later will appear with loss of sensation, falling objects ("I had to buy a new cup or plate"), loss of ability to perform delicate actions ("I can't unbutton my shirt"), and later weakness in the ability to hold objects. And use the hand for day-to-day functions ("It's hard for me to hold the cutlery").

How is carpal tunnel syndrome diagnosed?

The diagnosis is made based on accurate patient questioning and physical examination of specific signs. The diagnosis is also based on neural transmission - EMG for the upper extremities.

Is there a connection to work?

I often come across a question as to the connection between the onset of the syndrome and the work injury. In the medical literature, there was a connection between working with vibrating devices, working on a keyboard or mouse, repetitive work as well as ongoing use of hands under load and carpal tunnel syndrome. I write a legal medical opinion on the causal link between work and the appearance of carpal tunnel syndrome or other palm problems.

Carpal tunnel treatment

Conservative treatment focuses on night-time braces aimed at keeping the wrist in alignment

And cortisone injections into the canal that helps temporarily.

I use low concentration injections or doses in cases where carpal tunnel syndrome becomes eminent in pregnant women and for temporary benefit

Conservative treatment of carpal tunnel syndrome (CTS) can fit in mild conditions. One of the most effective treatments is wearing a hard brace that fixes the wrist and prevents bending and stretching that aggravate the symptoms. The brace can be placed on the hand during sleep and sometimes during the day. Another treatment that is appropriate in certain situations is cortisone injection into the carpal canal. Cortisone will reduce edema in the carpal canal and may reduce pain.

In cases where conservative treatment fails or when the syndrome is advanced, surgical treatment is sometimes needed.

Decreased sensation in the center of the palm, pain in the area of the palm. A rare but significant complication is injury to the median nerve itself.

Carpal tunnel syndrome after distal radius surgery is a recognized condition.

Often due to an innocent fracture that does not require a surgical intervention, a reaction of the flexor tendon of the hand is created when it is possible 

That trauma itself has also caused a tendon reaction or injury to the transverse carpal ligament itself, resulting in a carpal tunnel syndrome following injury: carpal tunnel syndrome post trauma.

In cases where a fracture repair of the distal radius is performed, the carpal tunnel release approach is used in each case and there are those that do not and both approaches are acceptable.

In view of this - the appearance of carpal tunnel syndrome after surgery to rectify a fracture of the radius is a normal and common phenomenon in such cases - a common complication or adverse finding but not medical malpractice.

מצב קשה של תעלה קרפלית - מה קורה כשמחכים המון זמן עם לבצע ניתוח של תעלה קרפלית. למה כדאי לנתח ניתוח תעלה קרפלית מוקדם - הסיבה היא שאם מחכים השרירים נחלשים.

בתמונה לפנינו יש פצע באצבע שנוצר מפומפיה. לאדם שנפגע כאן יש ירידה בתחושה בכף היד בעקבות תסמונת תעלה קרפלית קשה שהובילה לפגיעה בעצב המדיאני. קיימת פגיעה בתחושה העמוקה והשטחית של היד ולכן יש יותר נטיה לפציעה בבית או פציעה בעבודה ולכן יש מקום לעשות ניתוח תעלה קרפלית בשלב מוקדם. ניתוח שחרור תעלה קרפלית הוא ניתוח עם אחוזי הצלחה גבוהים מאוד ומוצלח מאוד. מנתח כף יד טוב ידע להסביר את הסיכונים בניתוח ולעשות ניתוח תעלה קרפלית בצורה טובה עם החלמה מהירה.

בתמונה זאת אפשר לראות את העצב המדיאני בצהוב בוהק ואיך הוא עובר בתעלה הקרפלית במהלך הניתוח לשחרור תעלה קרפלית חותכים את הרצועה מעל התעלה. הרצועה מתחברת בשנית אך הצורה פחות מתוחה וכך יש פחות לחץ בסופו של יום

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