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Carpal tunnel syndrome
This is a very common condition. The major sensory (feeling) nerve to the palm of the hand enters the wrist through a tunnel called the carpal (wrist) tunnel. This nerve, called the median nerve, shares the tunnel with ten other tendons. When the space in the tunnel gets smaller (which happens with a number of conditions... e.g. pregnancy, arthritis, injuries and soft tissue thickening that occurs with getting older), the nerve starts to "complain".
Symptoms are those of pain and/or numbness and/or tingling in the fingers, mainly the thumb and the next three fingers. This often occurs in the mornings. It is commonly in both hands.
Treatment consists of reducing any repetitive activities... e.g. typing, knitting or use of vibrating tools. A wrist splint can be quite helpful. Otherwise, a cortisone injection can be given. Finally, surgery can be done.
I obtain nerve tests prior to any surgery on a nerve because sometimes the problem can be due to something else (e.g. neck problems) and it is worthwhile making sure the diagnosis is correct before surgery.
There are two types of surgery for carpal tunnel syndrome:
1. Endoscopic carpal tunnel decompression
This is the more recent type of surgery using two very small cuts - one in the wrist and the other in the palm. An endoscope is inserted through these two holes and the carpal tunnel roof is divided under vision. Patients recover quicker with this surgery than with open surgery. However, I do not advise endoscopic surgery if the operation is a redo.
Post-operative guidelines for endoscopic carpal tunnel decompression
1. Keep the hand elevated until the next morning... e.g. by keeping it on a pillow or two overnight.
2. If you notice a definite increase in pain or numbness of the hand or fingers, you must contact Dr Popovic.
3. You are encouraged to keep your fingers and thumb moving so they don't become stiff. They don't have to be moved excessively. Just make sure you open and close your fingers and thumbs at least a few times a day.
4. Usually the bandage will be removed before you leave hospital. The thin tapes (Steristrips) will stay on and can be peeled off after three days.
5. Usually there'll be no stitches to remove.
6. You can wet your hand but don't let it get too soaked for two weeks (like a prune!).
7. It's important to keep your elbow and shoulder moving after the operation. Otherwise they may become stiff. You don't have to move them excessively. Just remember not to keep them immobile.
8. You are discouraged from using your hand for any heavy work for at least four weeks after surgery. Prior to this it is okay to use your hand for simple things... e.g. holding a fork or writing.
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2. Open carpal tunnel decompression
This is the operation that has been used for years and is very reliable. The main downside is that it requires a three or four centimetre cut on the palm and many patients find that the wound is sore for some months.
Post-operative guidelines for open carpal tunnel decompression
1. Keep the hand elevated until the next morning... e.g. by keeping it on a pillow or two overnight.
2. If you notice a definite increase in pain or numbness of the hand or fingers, you must contact Dr Popovic.
3. Keep your fingers still for the first post-operative night (the night of the operation) but after the dressing change the next day it's important for your healing and treatment to keep your fingers and thumb moving so they don't become stiff. They don't have to be moved excessively. Just make sure you open and close your fingers and thumbs at least a few times a day.
4. Usually the dressing will be changed at your local doctor's surgery on the first post-operative day. The thin tape (Steristrip) will stay on.
5. If the dressing becomes wet or dirty, change the dressing - you'll be given three or four to take home. The dressing should stay intact until your review. Usually there will be no stitches to remove.
6. Please try not to get your wound wet, at least until your first review appointment.
7. It's important to keep your elbow and shoulder moving after the operation. Otherwise they may become stiff. You don't have to move them excessively. Just remember not to keep them immobile.
8. You are discouraged from using your hand for any heavy work for at least four weeks after surgery. Prior to this it's okay to use your hand for simple things... e.g. holding a fork or writing.
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Ulnar nerve compression
The 2nd most common peripheral nerve entrapment is that of the ulnar nerve at the elbow. People are aware of the "funny bone". This is at the inside of the elbow where the ulnar nerve passes around bone and can be compressed to cause pins and needles down the forearm into the little and ring fingers.
The ulnar nerve can be caught in scar tissue at the elbow. This can produce serious weakness and wasting of the small muscles of the hand, resulting in a useless hand if not treated. Unlike carpal tunnel syndrome, there are really no effective non-operative treatments... i.e. surgery is really the only treatment.
Post-operative instructions for ulnar neurolysis
1. Keep the arm elevated until the next morning... e.g. on a pillow or in a sling.
2. If you notice a definite increase in pain or numbness of the elbow or hand and fingers, you must contact Dr Popovic.
3. Usually the dressing will be changed at your local doctor's surgery on the first post-operative day. The thin tape (Steristrip) will stay on.
4. If the dressing becomes wet or dirty, change the dressing - you'll be given three or four to take home. The dressing will stay intact until your review. Usually there will be no stitches to remove.
5. Please try to minimise wetting your elbow wound.
6. It's important to keep your shoulder, wrist and fingers moving after the operation. Otherwise they may become stiff. You don't have to move them excessively. Just remember not to keep them immobile. You can move the elbow within the limits of discomfort but are generally advised to minimise elbow movements and minimise driving. You are discouraged from using your arm for any heavy work for at least two weeks post-operatively, at which time your treatment will be reviewed.
7. Keep your elbow still for the first post-operative night (the night of the operation) but after the dressing change the next day it's important to try to move your elbow within the limits of discomfort. You are generally advised to minimise driving and other activities which may stress your wound until about two weeks after the operation.
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Meralgia Paraesthetica
Meralgia Paraesthetica means burning pain with pins and needles.
This occurs in the distribution of the lateral cutaneous nerve of the thigh - basically a hand-sized area on the front and outer side of the mid-thigh. This nerve only supplies feeling. It doesn't provide any movement.
The nerve becomes trapped below the inguinal ligament (the groin fold). This usually occurs for unknown reasons but can follow a significant gain or loss of weight, by wearing tight garments around the waist (e.g. a belt) or during pregnancy.
It usually occurs with standing or walking and is relieved by laying down with the hip flexed. It has nothing to do with the back.
Treatment involves attention to the above-mentioned causes. Otherwise a local anaesthetic plus cortisone injection can help.
Lastly, surgery can be performed as a day case under general anaesthesia to divide the tight portion of the inguinal ligament.
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