What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition that causes pain, sensitivity or weakness in the first three fingers of the hand. It happens when there is increased pressure on the median nerve in the wrist which impedes nerve impulses.
The surgical indication of the CTS
The median nerve is compressed at the level of the carpal tunnel as it runs under the anterior annular ligament. This leads to tingling, most frequently in the first four fingers, and joint stiffness (ankylosis) may be felt. This happens initially at night, and then more often with effort, or all the time. Motor signs such as dropping objects and a loss of strength may be observed. The end result can be a total loss of sensitivity, with amyotrophy of the hand muscles.
Qualification of the surgical indication
If your surgeon agreed, and having assessed the risks and benefits, you will have been offered open surgery to release the median nerve at the carpal tunnel. Your surgeon will have explained the alternatives. It goes without saying that your surgeon may, if necessary, and depending on the intraoperative findings or a difficulty encountered, proceed with another technique which they consider more beneficial to your specific case.
Your surgeon may request an X-ray. An EMG is essential for confirming the diagnosis and assessing the extent of the damage, but the diagnosis remains clinical.
Surgery is generally performed under local or regional anaesthesia. The surgeon makes a longitudinal or transverse incision. This involves opening the anterior annular ligament, which is the basis of the nerve compression, usually with a simple section of the nerve. A neurolysis of the median nerve or an associated tenosynovectomy may also be necessary.
Aftercare and follow-up of carpal tunnel syndrome operation
You will not need to stay in hospital overnight, and you can start to move your fingers and wrist immediately. A temporary splint may be prescribed. Subsequent monitoring of dressings, pain relief and follow-up appointments will be indicated by your surgeon on a case-by-case basis.
Open surgical release of the median nerve at the carpal tunnel is a well-coded surgical procedure. It is very effective for pain, with dysesthesia almost always disappearing immediately and complete recovery taking place within a few weeks. Recurrences are exceptional. A partial loss of sensitivity or strength may be observed, often in connection with a heavy compression, and the degree of recovery can remain unpredictable.
Potential complications of carpal syndrome surgery
- Most frequent:
- Haematoma: as with any surgery, there is a risk of haematoma, which generally resolves itself. In some cases, a puncture for haematoma evacuation or surgical drainage may be required.
- Algodystrophy is a painful, inflammatory condition that is still poorly understood. The condition is treated medically and can last for several months (or even years), leading to specific treatment, including adapted therapy, complementary assessments and, occasionally, specific pain management. Algodystrophy is unpredictable in its occurrence as well as in its evolution and potential after-effects. Taking vitamin C before the operation is a necessary preventative measure.
- More rare:
- A severe infection is exceptional. An infection may require further surgery and prolonged treatment with antibiotics. You are strongly advised not to smoke during the healing period, as smoking significantly increases the rate of infection.
- Nerve damage to the median nerve (entanglement in fibrous scar tissue or, in exceptional cases, severing of the nerve) is rare. On the other hand, reduced sensation or a fleeting hypersensitivity in one of the affected fingers may be observed.
- The scar may remain swollen and tender for several weeks. Pressing on the palm may be painful. Temporary stiffness may also be observed which could necessitate additional treatment.
This is a non-exhaustive list. As such, a particularly exceptional complication may occur, linked to the local condition or to a technical variability. Not all complications can be specified, and you have understood and accepted this.
What are the causes and risks factors for carpal tunnel syndrome?
The primary factors are age and gender. Carpal tunnel syndrome is more common in women than in men, and occurs more frequently between the ages of 40 and 50, and 60 and 70.
Diabetes is the second factor: 14% of diabetics are affected; 30%, when these individuals also present neurological complications.
Hormonal factors during pregnancy and menopause, hypothyroidism or severe chronic renal failure can lead to the development of carpal tunnel syndrome.
Lastly, the condition is also a musculoskeletal disorder, one of the most frequent occupational diseases linked to repetitive movements or postures.
Preparing for your hospital stay with ELSAN in France
How can I make an appointment ?
FAQ
How can I obtain a visa?
To obtain your visa for France, you will need to apply to the French Embassy in your country of residence. Once you have paid the care cost estimate provided by the ELSAN International Patients Department, you will be sent a letter of invitation and a certificate of payment signed by the hospital where your procedure will take place. These documents should be attached to your visa application.
What about follow-up treatment?
Depending on your personal situation, your medical team may recommend a rehabilitation hospital stay. This will be discussed with you.
How long before I can fly?
Your doctor will make specific recommendations. We suggest that you ask them to issue a Fit to Fly certificate, as depending on your medical situation, it may be necessary to respect a certain time limit in the interest of your health.
Will I be reimbursed?
For patients not covered by French health insurance, we provide an estimate of the cost of treatment. You should submit this estimate, along with your treatment plan, to your insurer to obtain their prior agreement, in accordance with your insurance policy.
In some cases insurers will pay directly (avoiding any advance payments by the policyholder) or reimburse the policyholder on proof of payment (paid invoice). This will depend on your insurance policy.