Carpal Tunnel Syndrome Treatment

Conservative and surgical treatment of carpal tunnel syndrome in Israel carried out by specialists in the Department of Orthopedics at the private hospital of Herzliya Medical Center. The department specializes in the treatment of acute and chronic diseases of the upper extremities, including occupational diseases and post-traumatic syndromes. The extensive experience of a multidisciplinary team ensures a patient’s rapid rehabilitation and restorative movement.

What is carpal tunnel syndrome?

Several tendons and the median nerve spread from the forearm to the hand through a narrow passageway called the carpal tunnel, which protects this main nerve of the hand. The carpal tunnel is bound by bones on one side and on the palmar side by the transverse carpal ligament located in the wrist region. The median nerve controls most movement and the feeling of the thumb and first three fingers.

Pressure on the median nerve by either swelling or any other factor that narrows the carpal tunnel (pinched nerve) leads to carpal tunnel syndrome (CTS), resulting in tingling, weakness or numbness in fingers or wrists.

The development of carpal tunnel syndrome can be caused by:

• Diabetes
• Prolonged repetitive hand and/ or wrist movements
• Hypothyroidism
• Pregnancy
• Peripheral neuropathy
• Inflammatory processes in the region of hand and wrist (rheumatism, rheumatoid arthritis)
• Inflammation of the tendons
• Degenerative changes of the ligaments
• Neoplastic processes (usually benign)

Carpal Tunnel Syndrome Symptoms

Wrist pain, numbness, and tingling are the main features, which cause patients to seek medical consultation. CTS occurs gradually with transient, intermittent numbness and tingling sensation of the thumb or three first fingers. This sensation leads to discomfort in the wrist and hand. The weakness of the hand is also experienced, a similar sensation to “pins-and-needles” – shaking or moving your fingers may help in the initial stages of CTS. Carpal tunnel syndrome commonly occurs in the dominant hand. Women are also more likely to develop CTS.

Carpal Tunnel Syndrome Diagnosis

Should the above signs and symptoms begin, it may indicate CTS. Should you experience any of the above discomforts, particularly if it interferes with daily activities, it is important to seek consultation. Avoiding or not treating CTS, could lead to permanent nerve and muscle damage – muscles of the thumb can waste away (atrophy).

A carpal tunnel syndrome diagnosis is based on typical complaints and a history of the disease. Hospital patients of Herzliya Medical Center in Israel are given a thorough examination conducted by a neurologist as well as an orthopedist. When indicated, additional visual methods (radiography, computed tomography, magnetic resonance imaging), functional (electromyography), and nerve conduction study diagnostics may be applied. Laboratory tests help professionals determine the presence of inflammatory processes, all of which contribute to analyzing the development of the disease and formulating an optimum treatment approach.

Carpal Tunnel Syndrome Treatment

Proper treatment can relieve the unpleasant sensations of CTS, and restore the hand and wrist function. The Department of Orthopedics at Herzliya Medical Center’s private hospital conduct integrated treatment of carpal tunnel syndrome, including:

• Determining And managing the factors which influenced the development of CTS (initial stages)
• Physiotherapy – carpal tunnel syndrome exercises
• Fixation of the wrist (usually overnight)
• Drug treatment of systemic diseases that cause the development of carpal tunnel syndrome
• Analgesics and anti-inflammatory drugs
• Steroid injections into the carpal tunnel, which has a prolonged action effectively reducing inflammatory swelling of soft tissue. This in turn substantially relieves pressure on the median nerve

If possible, patients are advised to modify activities that will prevent a recurrence of the disease, without resorting to surgery. Mild symptoms of CTS can be managed by avoiding overexertion of the wrists, ice pack on wrists, NSAIDs and wearing a wrist splint in the evening. Your specialist will determine the treatment you require, and whether surgery is needed – usually surgery is only performed when daily tasks become incredibly difficult, and home treatments are no longer effective.

It is important to maintain good posture, work with ergonomic equipment, stretch hands and wrists and to change one’s position throughout the workday, to avoid CTS.

CTS Treatment Procedure

Carpal tunnel syndrome surgery is recommended when conservative treatment and physiotherapy fail to relieve the symptoms of CTS. The goal of surgery is the decompression of the median nerve by dissecting through the transverse carpal ligament. The procedure improves blood circulation in the nerve trunk, which promotes rapid cessation of pain and recovery functions – this is done by relieving pressure on the median nerve by interfering with the ligament that disrupts the nerve. Herzliya Medical Center (HMC) in Israel performs surgical procedures for CTS under local anesthesia and as an outpatient basis.

HMC successfully perform two types of surgery for carpal tunnel syndrome:

• Open surgery – access to the carpal tunnel through an external incision (in the palm of the hand). During this surgery, the surgeon cuts through the ligament to free the compressed nerve. It does not cause any functional disorders and reduces the pressure in the channel region.
• Endoscopic surgery – a modern surgical technique that allows the surgery to be performed without having to make large incisions. During this procedure, there is access to the ligament through a small incision (in the hand or wrist) using a fiber-optic endoscope. The main advantages of endoscopic surgery for carpal tunnel syndrome are the lack of postoperative scarring and there is a quick recovery of hand function.

It is important to note that the long-term course of the disease may lead to scarring of the median nerve, which somewhat complicates the full rehabilitation of patients even after undergone surgical treatment.

Herzliya Medical Center effectively treats the symptoms of CTS, neurologists, neurosurgeons are among the specialists that work collaboratively to deliver effective and long-lasting treatment, as well as advice to patients in ways to prevent CTS recurring (returning).