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What is this Carpal Tunnel Syndrome (CTS) ?

In carpal tunnel syndrome, which is popularly called nerve compression, it is really the compression of the nerve called Nervus Medianus (Median Nerve) while passing through the Carpal Tunnel.

The Carpal Tunnel is a long tunnel-shaped structure on the palm of our hand, the base of which is the bones, and the roof is the structure called the Transverse Carpal Ligament. A few flexor tendons that go to the fingers of the hand pass through this structure, and there is also the median nerve. The most affected structure as a result of the decrease (narrowing) of the Carpal Tunnel for various reasons is the Median Nerve. In order to understand that the Median Nerve is trapped in the Carpal Tunnel, We first listen to the patient's complaints. CTS comes to our minds in complaints such as pain, numbness, tingling, burning, and especially at night. First, we perform the TINNEL test on our patient. With a soft examination hammer, we try to stimulate the nerve with small strokes at the points where the nerve passes on the palm side of the wrist. If symptoms such as pain, numbness, tingling, sensitivity, etc. occur in the fingers as a result of small strokes, we understand that the TINNEL TEST is (+).

Then, we request EMG (Electromyelography) rest to our patient to understand the degree of compression of the Median Nerve. This test is performed under the supervision of an EMG technician and a Neurologist. In the EMG test, it is tried to understand whether the signal transmission of the nerve is interrupted. In order to detect this, a low-voltage electrical current is given to the nerve and this is measured on the fingertips where the nerve goes. Roughly as a result of the test; It is evaluated as severe compression, moderate compression, mild compression and normal (no compression).

If there are signs of advanced CTS as a result of EMG, our patient should have surgery as early as possible. In moderate compression, the examination findings of our patient guide us. If medicated treatment has been applied but the complaints have not regressed, an operation is also required in Moderate Impingements. Our treatment is conservative in mild degree of compression. We treat it with medication and/or physical therapy and/or injections.

In CTS requiring moderate and severe surgery, the surgery consists of removing the compression of the Median nerve (Dekompresyon Surgery). Release the Transverse Carpal Ligament, which often forms the roof of the Carpal tunnel, is sufficient. In more advanced cases, if there is an existing narrowing in the sheath of the nerve, the nerve sheath can also be release.

Well, you have advanced stage CTS and what happens if you don't have surgery? The median nerve is a living tissue, and if it stays stuck, its microcirculation is disrupted at first and it no longer functions, and eventually it may die. When the nervous tissue dies, the already limited healing capacity loses its ability to heal irreversibly. In other words, the longer the delay in the treatment of CTS, the lower the chance of success in the treatment. The picture below shows the muscle wasting in the hand.


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