SURGERY OF THE HAND : THE SYNDROME OF THE CARPIAN CANAL
WHAT THE SYNDROME OF CARPIAN CANAL ?
The syndrome of carpian canal corresponds to the compression of the median nerve of the wrist. The median nerve ensures the sensitivity of the thumb pulps, the index and the middle fingers. It also ensures the motricity innervation of certain muscles of the thumb mainly the thenarian muscles.
When the canal narrows down, either by an external cause (osteoarthritis-fracture), or when the synovial which surrounds the tendons thickens, then a clash content-container appears. The first element which suffers is the nerve. The passage of the electric impulse is slowed down: intense sensitive symptoms appear.
WHAT ARE THE SYMPTOMS OF THE SYNDROME OF CARPIAN CANAL ?
The syndrome of carpian canal is deciphered at the beginning by subjective signs like swarming, a feeling of numbness, sometimes of the pains of the thumb, index and middle fingers, even of the ascending pains into the forearm and the elbow. The affection of the 2 hands is very frequent.
Generally, these signs appear in second part of the night and awake towards 3am. They disappear by shaking the hand during a few minutes.
Later on the affection of motricity fibres involves a reduction in the grip strength of the thumb with a releasing of the objects in the everyday life.
The examination also makes it possible to detect objective signs with a disorder of the recognition of the small objects with shut eyes (needles, switches, button of shirt…), a reduction in muscular volume at the base of the thumb. The pressure of the median nerve or the forced bending of the wrist involves the appearance or the stressing of the disorders.
WHICH COMPLEMENTARY EXAMINATIONS ARE USEFUL ?
In certain cases, radiography of the wrists and hands are required to eliminate the possibility of a post-traumatic contraction. Radiographies of the cervical rachis can be also useful to eliminate a possible upstream compression associated with compression for the wrist. The electromyogramme confirms the affection of the nerve and makes it possible to quantify it.
PRINCIPLE OF THE INTERVENTION
The intervention aims definitively to lower the pressure in the carpian canal and to release the median nerve. The intervention consists in opening the thick former ligament which closes the canal. The synovial one which surrounds the tendons can be removed when it is thickened or pathological.
This intervention is carried out under local anaesthesia or loco-regional of the upper limb (no general anaesthesia): So you do not spend the night at the clinic.
When the intervention is carried out in a traditional way ("mini-open" incision), the scar is longitudinal, in the palm. This surgery intervention can be also made by endoscope way.
After the intervention, night swarming generally disappears since the first night. On the other hand, when there was a reduction in sensitivity during the day, the symptoms disappear often only after several months, because of the slow recovery of the nerve. A nerve "grows back" at the speed of a millimetre per day.
WHAT IS THE USUAL EVOLUTION AFTER THE INTERVENTION ?
The patient keeps the large bandage a few days without wetting it and avoiding the big efforts. It is necessary to move the fingers in the most normal way.
It is normal to suffer a little the first day after the intervention. These pains disappear by taking a banal analgesic. The pain of the intervention disappears into 1 to 2 days. In the event of manual work, a standstill of work from 2 to 3 weeks is usual. The force and the total sensitivity restores after the 3rd month.
DURATION OF STAY
The intervention proceeds into ambulatory, then one week convalescence at the hotel is necessary.
WHAT ARE THE SPECIFIC RISKS ?
The specific risks are related to the section of the ligament in the ring finger.*There are vascular cases of wound per section of the palm arcade or the cases of wounds of the median nerve or the close ulnar nerve; sometimes also of the flexor ones.
The hitches remain exceptional.
I wish to be called back freely and without engagement on my ground line...
{mots_cles}Votre
chirurgie esthétique en Tunisie : liposuccion, lifting, chirurgie
des seins, abdominoplastie, plastie abdominale, augmentation mammaire,
réduction mammaire, blépharoplastie, chirurgie des paupières,
rhinoplastie, traitement de la calvitie. Médecine esthétique
en Tunisie : toxine botulique, botox, comblement des rides, cure d'amincissement.
Votre chirurgie othopédique en Tunisie : prothèse de hanche,
prothèse du genou, canal carpien, doigt de Ressaut, rizarthrose.
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