Can CPS show up at night

Carpal tunnel syndrome surgery


Important NOTE:
The description of the interventions was compiled with the greatest care. However, it can only be an overview and does not claim to be complete. For further information, the websites of the service providers and the personal consultation with the doctor or the surgical explanation in the respective operating facility are used.
The persons responsible for the content of this website do not guarantee the completeness and correctness of the information, as constant changes, further developments and specifications are made as a result of scientific research or adaptation of the guidelines by the medical societies.

Here you will find:

In the area of ​​the wrist, nerve cords run together with nine flexor tendons below the tight middle ligament that runs across the underside of the wrist. A narrowing in this area can lead to pain and sensory disturbances - this is referred to as carpal tunnel syndrome.
The pressure on the middle nerve (median nerve) is initially noticeable as "falling asleep" or "tingling" (pins and needles) on the fingertip of the middle finger. It is also often stated that the hand feels swollen. Later on, pain also occurs, which mainly occurs at rest - and therefore preferably at night. If the disease progresses, a persistent feeling of numbness can develop, especially in the thumb, index and middle fingers. If the disease remains untreated, it can also lead to a decline in the ball of the thumb muscles with a weakening of strength development.
Carpal tunnel syndrome is particularly common in menopausal women. The exact cause cannot usually be determined. Computer work with a mouse and keyboard seems to pose a certain risk factor. Usually the working hand is affected first, but nerve entrapment often occurs on both sides. In rare cases, carpal tunnel syndrome can also occur as a result of a broken bone or a tumor in the wrist area.
A surgical procedure that can be carried out on an outpatient basis can give the nerves sufficient space again.

What happens during this procedure?

In the case of interventions on the hand, the option is usually used to operate in a bloodless state in order to keep blood loss as low as possible and to give the surgeon a better overview. To do this, a rubber bandage is wrapped tightly around the arm in question, starting with the fingers. If the veins are largely empty of blood, a blood pressure cuff on the arm is inflated to prevent the blood from flowing again during the procedure. The rubber bandage can then be removed again.
In the case of carpal tunnel syndrome, there is the option of operating either “openly” or “minimally invasive” with special optical devices (endoscope) through a “keyhole”.
In open surgery, after a skin incision is made on the inside of the wrist, the connective tissue middle ligament (retinaculum flexorum) is cut in order to create more space for the nerves. If necessary, benign soft tissue tumors or a thickened tendon bearing tissue, which may exert pressure on the nerves, are removed.
In the minimally invasive (endoscopic) procedure, the narrow surgical instrument is inserted into the palm of the hand through two small skin incisions and the pressure on the affected nerves is relieved by severing the central ligament from “inside”. The main advantage of this approach is faster healing and less scarring.
At the end of the procedure, the incisions are sutured and a firm bandage is put on. Depending on the type of operation, a small plastic tube is inserted to drain off wound secretion, which is removed after a few days.

When does the doctor advise you to have this procedure?

Surgical treatment of the carpal tunnel syndrome is always advised when conservative therapy with rest, nocturnal splinting or cortisone injections has not brought about sufficient improvement. Surgery is usually recommended even if the squeezed nerve already shows clear signs of failure such as impaired tactile sensation or a weakening of the muscles it supplies.

Immediate surgery is indicated in the rare acute or rapidly progressing courses. If the carpal tunnel syndrome is caused by other diseases or injuries, such as poorly healed fractures or dislocations of the carpal bones, this must also be addressed during the operation.

Whether you can have keyhole surgery (endoscopic) or an open procedure is better, the doctor must decide on the basis of the respective circumstances.
If both hands are affected, with the exception of emergency situations, only one side is operated on first so that one hand is still available after the operation. Only when the operated hand is fully operational again is the second operation planned on the other side.

Which stunning method is usually used?

The aforementioned procedures on the wrist are usually carried out under intravenous (IV) regional anesthesia or plexus anesthesia.

How long does the procedure take on average?

The duration of the procedure depends on the procedure and the anatomical conditions.

Who may not be suitable for this procedure?

During pregnancy, one is reluctant to operate a carpal tunnel syndrome because it is possibly due to an increased tendency of the tissue to swell, which decreases again after the birth. Sometimes carpal tunnel syndrome also occurs in the context of certain underlying diseases such as diabetes mellitus or rheumatoid arthritis. In such cases, the doctor may first recommend optimal treatment for the underlying disease.
If the nerve is already so badly damaged that it has become more or less functionless and the muscles it supplies have already atrophied, the operation may no longer bring about any improvement.

How is the risk to be assessed?

Surgical therapy for carpal tunnel syndrome involves relatively low-risk interventions.

As with any operation, of course, complications cannot be completely ruled out. Your doctor will explain to you in detail about rare complications such as secondary bleeding, injuries to neighboring structures, wound infections or excessive scarring before the procedure.

As small cutaneous nerves may be severed by the cut, a feeling of numbness can remain in the surgical area.

The chances of success for both operations are very good. With carpal tunnel syndrome, the pain often subsides immediately after the procedure. However, it can take a few weeks for the median nerve to fully recover from the bruise. In very advanced cases, the numbness (sensitivity disorders) or muscle wasting that existed before the procedure no longer regress.

What do you have to consider before the procedure?

If you regularly take medication for other illnesses, you should inform your doctor or anesthetist in good time beforehand, as some medications such as blood-thinning substances should be discontinued a few days before the procedure.

What happens after the procedure and what should you watch out for?

Even with outpatient procedures on the wrist, you will remain under observation for some time after the procedure - until you feel fit for the way home. The numbness of the arm may continue for some time. You should not drive yourself on the day of the procedure and should not use public transport on your own. Have family or friends pick you up or take a taxi home.
After surgery for carpal tunnel syndrome, you will have a tight bandage for about 7-10 days. In some cases, the doctor also recommends a plaster splint, which is then put on immediately after the operation.

However, you should move your fingers from the beginning and avoid letting your hand hang down if possible. The doctor may also recommend physiotherapy. The sutures are pulled after 8 to 14 days. Under certain circumstances, this is followed by a follow-up treatment with baths in lukewarm water, cold treatments or the like.

Basically, the hand should be moved, but not stressed for the first 6 weeks. Anything that goes beyond lifting a cup of coffee is called a rule of thumb. If the hand is put too much strain too soon, this can be noticeable through pain and swelling.

Scars in the hand area are usually more sensitive than in other areas of the body, as the sensory nerves are particularly dense here. In the first few weeks, they can therefore still be perceived as very annoying. Even if the scars are red and thick in the first few months, she needn't worry. After a year or two, they are usually barely visible.

When does the next doctor's appointment usually take place?

On the day of the procedure, your doctor will tell you when you should come back for the next check-up. In your own interest, you should absolutely keep this appointment.
If you get swelling, severe pain or fever at home, or if the bandage is pressing, you should contact your doctor immediately. Even if you are unsure and still have questions about the normal course of healing, in practice no one will be angry with you if you call for advice.