Therapy of a carpal tunnel syndrome


The Carpal tunnel syndrome is caused by the bottleneck of a nerve in the area of ​​the wrist. This narrowing can lead to Pain and loss of sensitivity to lead. Accordingly, the therapy is mainly aimed at creating more space for this nerve and alleviating the symptoms. Depending on Cause of carpal tunnel syndrome the therapy turns out differently.

Conservative therapy

Were the complaints caused by a severe overload of the wrist, the therapy of choice is the one Protection of the affected joint. However, if the stress lasts longer, for example in the professional context, further help or a change of profession should be considered.

Wrist brace

If the symptoms are mild, with no major impact To have on the function and mobility of the hand, therapy can only consist of the Hand seemed to shine during the night hours. This is done using a Wrist splint and is intended to ensure the best possible blood circulation, since most people have bent their wrists at night and thus the blood circulation in the hand area deteriorates. Except the Fixation in the neutral hand position this wrist splint exerts a slight pressure, which is supposed to counteract inflammation.

Treatment with NSAIDs

Pain relief can be achieved by taking anti-inflammatory and pain relieving medications. Non-steroidal anti-rheumatic drugs (NSAIDs) meet these requirements and are probably the most commonly prescribed drugs in orthopedics and are not alone Rheumatics reserved, as the name might lead you to believe. They work reliably up to a certain degree of pain.

Products of 1st choice for carpal tunnel syndrome are NSAIDs like Diclofenac (Voltaren®),
Ibuprofen (Imbun®), Indomethacin (Amuno®), Naproxen (Proxen®) or Piroxicam
Main advantage of NSAIDs over traditional pain relievers like Acetylsalicylic acid (Aspirin®) or Paracetamol (Benuron®) is hers strong anti-inflammatory Effect. They work at the place of
Pain development calming. The inflammatory tissue can swell and possibly become a Pressure reduction lead in the carpal tunnel.

Like all drugs, NSAIDs also possess Side effects. The main problem is that damaging influence the NSAID on the stomach and intestines, especially with long-term therapy. Upper abdominal pain, nausea, diarrhea and even bleeding stomach and intestinal ulcers can result.
Therefore, it can be useful to stop taking NSAIDs at the same time as one
Gastric protection preparation to combine.

NSAIDs are also available in the form of Anoint or Gels for external use
(Voltaren Emulgel®, Ibutop Creme®). When used externally, there are almost none
Side effects, however, the effectiveness is also significantly lower. Be rare
local allergic reactions observed.

Appointment with a hand specialist?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
I don't want to join the ranks of "quick knife pullers".
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me at:

  • Lumedis - orthopedics
    Kaiserstrasse 14
    60311 Frankfurt am Main

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Further information about myself can be found at Lumedis - Dr. Nicolas Gumpert

Cortisone therapy

Is the Inflammation more pronounced can additionally cortisone administered.

Local infiltrations with a cortisone preparation (15 mg methylprednisolone) by means of a syringe into the carpal tunnel are possible, but they contain Risk of nerve injury (maximum 3 injections). Cortisone is anti-inflammatory and is said to calm the hypersensitive median nerve.

Oral cortisone therapy in Tablet form can be promising. Prednisolone 20 mg is recommended in the morning for 2 weeks, then 10 mg for a further 2 weeks.

Both forms of therapy should only ever have one relatively short period be used because cortisone is in the Long-term therapy severe side effects having.

Vitamin B supplements

vitamin B is said to have a stabilizing and calming effect on nerves, which is why it is prescribed more often for nerve damage of any kind. Since there are virtually no side effects, an attempt can be made, even if one positive effect on carpal tunnel syndrome not scientifically proven could be.

Treatment with ultrasonic waves

There is also the possibility of alleviating the symptoms with the help of ultrasound waves.
The therapy options mentioned all fall into the group of conservative therapy, which is suitable for mild to moderate disease courses.

Operative therapy

There are two different therapy methods to choose from for surgical therapy.

Holds that Tingling in the fingers or the Function restriction the hand longer and if the above measures no longer improve, surgical therapy is an option. It will tape (Ligamentum carpi transversum or Carpal band) split, which limits the carpal tunnel upwards like a roof, thus avoiding the trapped To free up nerves more space.

This type of surgery is mostly done by one Hand or neurosurgeons carried out and takes place in local anesthesia. It can therefore also be carried out on an outpatient basis. An advanced age or an existing pregnancy are not contraindications, since overall fewer complications are to be expected with this minor intervention.

There are two surgical procedures available, open and endoscopic or closed surgery.

Open surgery

In the open surgery the surgeon does one Skin incision in the longitudinal axis of the forearm at the level of the wrist. This gives him the best possible view of the Carpal band, the underlying nerves and other structures that run through the carpal tunnel. It first cuts the ligament and also removes excess tissue in the carpal tunnel itself in order to give the nerve more space in it. This type of surgery is chosen when the Anatomy of the wrist deviates from the norm, it's a repeated surgery acts in the same place or when the wrist function is already severely restricted.

Besides the general risks of the Bleeding, infection and swellingthat are present in any procedure, certain other complications can arise in open surgery. For example, a Nerve injured which can cause numbness in the affected fingers.In very rare cases it can also become very painful persistent Soft tissue swelling come with decalcification of the bone. In the context of this disease, namely the Sudeck's disease finally to Joint stiffeners. In addition, the scar can be very sensitive to touch or stress for a few weeks and, in the worst case, become infected.

Endoscopic surgery

In the endoscopic surgery the surgeon does one very small skin incision on the wrist through which he guides his instruments and operates there. The advantage of this type of operation is, of course, that the actual incision is smaller and therefore with fewer complaints goes hand in hand. In addition, the hand can be loaded again earlier after endoscopic operations than with open ones.

But in the end it is Result of both surgical procedures as equivalent consider. Possible dangers of the endoscopic procedure are the somewhat increased risk of nerve damage, since the view of the structures is reduced compared to the conventional procedure. If difficulties arise during the operation, it may also be that to switched to open surgery must become.

Also worth mentioning is the so-called Snap finger, the most frequent late effects in both surgical procedures. This can happen if a Tendon sheath injured or pinched becomes. Individual fingers can then snap or be very painful. However, this can usually be remedied with a renewed intervention under local anesthesia.

The Regression of deafness in hand after the procedure can sometimes last a few weeks. This is particularly the case with patients who have already suffered from severe failures due to carpal tunnel syndrome before the operation. Usually, however, the sensation of touch returns sooner or later, and possibly after another operation. In exceptions but can numbness to last a lifetime, especially in patients who entered treatment very late.

After the operation

Immediately after the operation, a plaster cast created to immobilize the arm for about a day. By Elevation swelling can be avoided. Against the pain can common Pain medication are used. It is important, however, that already after the first 24 hours after the procedure Finger exercises should be started.

The Threads of the skin incision are approx pulled eleven days after the procedure and should be kept dry until then. For example, a plastic bag over your forearm when showering is suitable.

It is also important to be on the affected arm during this time nothing heavy to lift and nowhere to support it.

After both types of surgery, however, it is important as early as possible with exercises for the wrist and fingers to encourage mobility as much as possible. Especially the Stretching the arms and wrist have a very positive effect on the healing process, even if this may cause some pain shortly after the operation. The whole thing should be done over one to three weeks. After that, the hand can and should be used again as it was before the procedure.

If, on the other hand, the hand is spared too much during this period, further complications such as swelling or an increase in pain can occur.

Inability to work after the operation

The duration of the incapacity for work depends on the extent to which the arm has to be used at work. However, after such an operation usually a three to four week break from work will and no sport become. Depending on the type of employment is a However, they can return to work earlier, even with low stress and later with heavy loads than possible after four weeks.