Hand | Nerve Compression Syndromes

Nerve Compression Syndromes

Our nerves are the communication organs between brain and muscle or skin. These can be compressed at certain anatomical points. Relatively simple procedures can relieve these anatomical conditions. The best-known example is carpal tunnel syndrome.

What are nerve compession syndromes?

As the name suggests, these are syndromes in which the nerves are constricted. In principle, any nerve can be constricted at any anatomical location. Due to the anatomical comprssion, which are dependent on the respective nerve, there are corresponding symptoms such as tingling, pain, sensory disorders and even paralysis. Above all on the hand such sensory disturbances are perceived relatively quickly. In the best-known example, the carpal tunnel syndrome, the median nerve is compressed in the area of the wrist and typically leads to nocturnal pain and discomfort. If the constriction persists, the symptoms can range up to paralysis of certain muscles. As a rule, however, severe pain occurs beforehand, so that patients usually seek medical treatment early. Another well-known example is cubital tunnel syndrome. Here, the ulnar nerve in the area of the elbow is affected.

Compression of the median nerve in carpal tunnel syndrome

When is surgery necessary?

This depends on the localization, the nerve affected, the complaints and the patient’s wishes. In certain cases, infiltration and immobilization can provide relief or healing. If the symptoms persist, surgical relief of the anatomical compression site is often unavoidable. If the symptoms of carpal tunnel syndrome persist despite infiltrations and/or immobilization, the intervention is indicated. This is particularly the case since surgical decompression is usually the definitive solution.

Am I the right candidate for surgery?

If you suffer from tingling, dull pain, numbness or muscular weakness, a nerve compression syndrome such as CTS can present itself. In any case, a clinical examination and a detailed discussion for clarification are necessary. In addition, if not already done, an additional neurological examination with ENMG or ultrasound should be arranged. If the symptoms are not particularly severe, a solution can be achieved by immobilization or infiltration. Such compression neuropathies are also known in the area of the lower extremity. Examples are the meralgia paraesthetica nocturna with burning pain in the area of the outer thigh or the tarsal tunnel syndrome with corresponding complaints in the area of the sole of the foot.

What can I expect?

The result again depends on the diagnosis and the therapy. In the surgical release of the carpal tunnel, good to very good results with complete freedom from symptoms can be expected. If the symptoms have been present for years, there is usually no complete recovery of the sensory disorders, but the pain disappears postoperatively as expected. The results in cubital tunnel syndrome are also good, with some patients having to undergo major surgery with transposition of the nerve. Individual pre-existing conditions or previous operations may have a significant influence on the final result.

What happens during consultation hours?

During the initial consultation we will try to make a diagnosis. Here the conversation regarding the complaints and the examination is decisive. Imaging is used for special questions. Usually by ultrasound or MRI. An extended neurological clarification is standard nowadays. In particular, electroneuromyography (ENMG) brings additional diagnostic benefits, so that the postoperative result can also be better predicted. In any case, a detailed explanation of the planned intervention or conservative therapy is given.

What's the surgery like?

Depending on the diagnosis, the surgical intervention is planned. Simple nerve release (decompression) in the area of the elbow or hand is performed on an outpatient basis under local or regional anesthesia. If additional procedures such as synovectomies or muscle shifts are necessary, the procedures are performed under inpatient conditions. In any case, we try to keep the procedures as simple as possible so that no additional and unnecessary scarring occurs.

What about the follow-up treatment?

Since every intervention, no matter how small, involves a certain risk of complications, certain measures should be observed. The first few days you will feel normal, timely pain, which can be relieved with painkillers. For larger operations, in-patient stays are the rule. Regular wound checks are carried out to ensure safe wound healing. Depending on the anatomical region affected, immobilization may also be necessary. A hand-therapeutic accompaniment to mobilisation may also be indicated. All follow-up treatments have in common the goal of early movements with the greatest possible safety and freedom from pain. The follow-up treatment is already discussed in the initial consultation so that you can plan the postoperative phase already and any help for everyday life and inability to work can be organized.

What are the risks?

Every intervention, however small, involves a certain risk of complications, since an operation in the broadest sense always leads to tissue injuries. A complication does not necessarily occur due to an error. Rather, the human body reacts individually and has certain tendencies to complications. The initial clarifying discussion serves to address such tendencies and to take appropriate precautions.

General risks of an operation are

  • secondary bleedings
  • wound healing disorders
  • infections
  • excessive scars
  • thromboses
  • embolisms

Specific risks of nerve compression syndromes depend on the diagnosis and localization of the operation. It should be noted that operations on nerves can cause irritation or even severe pain.  We will be happy to advise you specifically in the context of surgery clarification.

Do you have the impression that you have a nerve compression syndrome or a diagnosis such as carpal tunnel/cubital tunnel syndrome has already been made?

As carpal tunnel syndrome is one of the most common hand diseases, the symptoms are known to many non-medically trained people. The typical sensations of numbness do not always occur, but rather dull pain radiating into the forearm. In certain cases, the pain can radiate into the shoulder area. We are happy to advise you in the context of an initial consultation on referral by the family doctor or directly with us. Please note whether you are in an HMO or other general practitioner model and inform your general practitioner.  During the initial consultation, we will work out the diagnosis together and, if necessary, take the first therapeutic steps. An operation will always take place later and should be well weighed.

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