Saarland University Medical Center and Saarland University Faculty of Medicine
Carpal tunnel syndrome

Carpal tunnel syndrome

Carpal tunnel syndrome is by far the most common nerve compression syndrome. For the majority of patients carpal tunnel syndrome occurs on both hands. The disease is caused by an anatomical tightness in the wrist, which permanently compresses the median nerve.


The classic symptoms are nocturnal paresthesia of the affected hand (so-called "brachialgia paraesthetica nocturna"), along with a tingling and numbness of the thumb, forefinger and middle finger. Symptoms in the entire hand are possible. In some cases it can also lead to pain in the area of the shoulders. Muscle atrophy in the area of the base of the thumb is possible over a prolonged course.

Due to the anatomical cause the surgical therapy is the treatment of choice in order to permanently resolve the carpal tunnel syndrome.


For many decades, an open cleavage of the so called transverse carpal ligament - the band tissue, which "covers" the carpal tunnel - was performed. In recent years increasingly endoscopic techniques to split the transverse carpal ligament have been applied successfully. The long-term results are comparable to those of the open surgical technique.


In our Department of Neurosurgery both the open technique and the endoscopic technique are applied regularly.

 

Typical endoscopic view of the end of the transverse carpal ligament (arrow): The limit of the operating range is performed by the endoscopic shaft. The view in the carpal tunnel is carried out from the area of the palm (distal) from in "line of sight" wrist (proximal).

 

Depiction of the imported "pulling knife" by which the thick ligament transverse carpal is severed. Note the pronounced enlargement - the inside diameter of the endoscopic shaft is only 5 mm.


Transection of the transverse carpal ligament. Fat (arrow) falls from the hand region into the carpal tunnel - this confirms the complete severing of the tape.