-Do you feel numbness, burning pain or tingling in your hands and wrists?
– Are your complaints more pronounced, especially at night?
-Do you have difficulty holding objects in your hand without dropping them?
-Is it increasingly impossible to painlessly perform repetitive hand movements, such as using a computer keyboard or mouse?
If your answer to these questions is yes, you may also have a nerve entrapment disease called carpal tunnel syndrome. Half of the cases are related to occupations and among all occupational groups-related diseases and injuries, it is the situation that causes the most loss of workforce.
According to US data, approximately 260,000 carpal tunnel cases are operated on each year.
Carpal tunnel syndrome occurs as a result of inflammation of the nerve in the wrist as a result of the combination of thickening of the band on the median nerve and repetitive movements. It is frequently observed especially in women aged 40-60, in professional groups that use their hands excessively such as pianists, hairdressers, computer operators, bankers, dentists, sculptors, housewives.
Pregnancy, diabetes, thyroid diseases, menopause, broken or displaced bones in the wrist and excessive obesity increase the incidence of the disease. Frequent and vigorous gripping of objects with the hands increases the incidence of flexion of the wrist and arthritis.
After the first appearance of these complaints, it is very important to seek treatment without delay. Do not wait for the pain to increase excessively and exceed the limits of tolerance to apply.
The main goal of non-surgical conservative treatment is to end or reduce repetitive injuries to the median nerve. For this purpose, wrist movements can be restricted with a wristband to remove the pressure on the nerve. If this does not work, anti-inflammatory drugs can be prescribed to reduce edema or cortisone injections can be given to the wrist. A number of special hand and wrist exercises can be recommended to reduce pain.
If patients cannot get rid of their pain with rest, rehabilitation, or other non-surgical treatments, different surgical techniques can be applied to relieve pressure on the median nerve. The most commonly applied technique is the method called carpal tunnel release and can be applied with open or endoscopic methods. In open surgery, an incision is made in the wrist area and the band that creates pressure on the median nerve is cut and the nerve is released. In the endoscopic method, a smaller incision is made and the tunnel is viewed with a miniature camera and the tape is cut.
A new technique in Carpal Tunnel Release: Mini Open Approach
The standard approach for carpal tunnel release is the carpal ligament cut with open surgery. With this standard approach, the results are generally pretty good. However, pain due to scar tissue after surgery and limitation of movement in the wrist are important problems. Wound healing is delayed due to the relatively long incision. Another problem is intense pain in the palm muscles called Pilar syndrome. Complication rates vary between 1-20%. For this reason, in the early 1990s, minimal approach techniques with the endoscope were used to reduce the incision length and thus overcome these problems. With this technique, the problems related to the wound site have been resolved, but the frequency of injuries to the median nerve, vessels, tendons and even the ulnar nerve has increased. At the same time, the duration of surgery was significantly prolonged. Since the procedure uses an endoscopic system, it needs to be done in a hospital environment.
Mini open approach is a new surgical method developed considering all these problems. As in endoscopic surgery, a small incision is made and a tunnel is created between the median nerve and the carpal band. At the same time, a second tunnel is opened between the carpal band and the subcutaneous tissue so that the band is fully exposed. The tape is then cut with a special laser knife, knifelight.
The most important advantage of the Knifeligt over the endoscopic approach is that it is not required to be performed in a hospital environment since it does not require endoscopy instruments. The processing time was significantly shortened. It has greatly reduced the problems such as scar tissue formation, pain in the operation area, pilar syndrome, which can sometimes disturb the patient after open surgery. Wound healing is extremely shortened due to the short incision and minimal injury to the subcutaneous tissues. After open surgery, problems such as suspension and immobilization of the arm for 2 weeks disappeared.
With this surgery, patients start to use their hands for light work the day after the operation and the hand is not suspended. There is no difference between open surgery and surgical results.
The advantages of this new technique in brief:
Maximum tissue preservation
Technically simple
Significant reduction in surgical time
No need for the use of an endoscope
Low cost for the patient
Reduction of the recovery time after the operation
Reduction of redness, tenderness, and pain that may occur in and around the surgical site after the operation
Reuse of the operated hand, very short return to work
Protection from carpal tunnel syndrome, golden advice on correct use
avoid prolonged and forceful up-and-down movements of the wrist, tensely holding something with fingers (such as a sewing needle), bending the wrist towards the thumb or little finger
Palm be careful not to carry loads facing up
Avoid tight bands (such as wrist watches) (98 00703) Avoid extreme cold or unprotected vibration
Bring frequently used objects such as phones as close to your work area as possible. So avoid over-reaching.
While driving, do not hold the steering wheel too tightly when carrying items. Rest as much as possible.
When using a typewriter or keyboard, rest your hands every 15 minutes.
Avoid holding objects such as paint brushes, pens, newspapers, or books for a long time
General posture of the body is very important when using the hands. The height of the work area should be adjusted to allow the wrists to remain in a neutral or nearly straight position while sitting or standing. During the work, care should be taken to ensure that the shoulders are free enough and the elbows are comfortably at the sides.
While sitting, the feet should be on the ground with the back and waist well supported. The sitting chair should be adjusted according to each individual.
Posture is especially important in types of typing and keyboard use. A properly adjustable seat, sufficient light and appropriate height for the table are helpful.
While typing, keys are pressed frequently for a long time. That’s why it’s important to touch the keys as lightly as possible. Pressing the keys too hard will cause unnecessary fatigue. To overcome this problem, it is useful to give frequent short intervals. It is also important to routinely relax the neck, shoulder and arm muscles.
The selection of hand tools is important. The grip of the handpiece should be proportional to the size of your hand.
When you learn a new hand-intensive job, give your hand time to get used to the new job. This is just like an athlete preparing for a race or other athletic competition.
Take breaks at sufficient intervals to allow the hands to rest.
If you are wearing gloves, they should be hand sized. If it is too large, the effort required to hold the object will be more, if it is too tight, the hands will be squeezed.
