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Carpal tunnel release

1. The median nerve penetrates into the hand by a channel at the level of the wrist. This channel, constituted by an osseous gutter, is closed by a powerful ligament. The flexor tendons and the median nerve make a commitment in this conduit. The syndrome of the carpal tunnel is the compression of this nerve, mostly by the ligament.

2. The felt disorders are characterized by dullnesses of the first 3 fingers (rhumb, index, middle finger) and of the external edge of the 4th, the sensations of itches, burns, gladly more frequent at night or in the awakening. If add to it pains of the hand which often go back up forwards arm, the elbow, even the shoulder. When the disease evolves, appear a certain clumsiness, a loss of the sensibility, even a deficit of the thum with a muscular amyotrophia.  A electrophysiological study is mostly practised (recording of the electric current conveyed by the nerve). He specifies the importance of the nervous achievement and the place of the compression as well as the possible association of an achievement of the ulnar nerve (4th and 5th fingers).

canal carpien3. At the beginning a night-splint associated with a infiltration maybe tried. The surgery aims at splitting the previous ligament, mostly by endoscopy. The camera is introduced by a 1 cm section practised in the wrist. The absence of scar at the level of the palm of the hand facilitates postoperative period. No splint is organized and the re-use of the hand for the gestures of the everyday life is encouraged from the next day.The intervention is practicable under local anesthetic in extern during a stay of a few hours. A strip slightly compressive must be take off by the patient the day after the intervention. The ablation of the small bandage and the stitch will be made by a nurse towards the 10°day.

A weak leave of about fifteen day is usual in case of office work, he can go 2 months in case of work of strength. Indeed if the itches and the night-pains disappear from the next day, a pain compared to the ligament at the level of the palm during the efforts, associated with a lack of strength, persists 2 in 3 months.

4. The complications remain rare, if the intervention is realized by a pulled surgeon:

  • The infection controls itself rather easily when the diagnosis is premature : abnormal pains, pulsatiles, important inflation and redness.
  • A swollen, painful hand, with perspiration, then steepness is rare but worrisome (CRPS);
  • The nervous hurts are exceptional...
  • The recurrence remain rare, but possible.
 
 
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