Peripheral Nerve Entrapment and Carpal Tunnel: A Complete Guide to Recovery

Do you wake up at night because of numbness in your hands? Or perhaps you feel the need to “shake” your hands in the morning. You might even experience weakness while holding a tea glass. However, do not let this situation scare you. You likely face a problem in the “Peripheral Nerve Entrapment” group. Specifically, Carpal Tunnel Syndrome represents the modern age’s most common hand disease. But do not worry. Because you can completely get rid of these pains with the correct diagnosis and microsurgical methods. Thus, you regain your old strength.

Our hands connect us to life. Unfortunately, every pain you experience while using them lowers your quality of life. As the Neurosurgery team, we know this process very well. In addition, we understand you. Therefore, we prepared this guide to answer all the questions in your mind. You will find the cause of the disease, symptoms, and the most up-to-date treatment methods here. As a result, you start treatment consciously.

What is Peripheral Nerve Entrapment?

Think of the body as an electrical network. The brain acts as the main switchboard. Meanwhile, the spinal cord functions as the main cable. We call the thin cables exiting this main cable and traveling to arms and legs “peripheral nerves.” Primarily, these nerves carry the “move” order to muscles. Furthermore, they carry sensations like “hot, cold, pain” from the skin to the brain. However, sometimes these nerves pass through narrow tunnels. Consequently, the nerves get trapped in those narrow points. They remain under pressure. As a result, the nerve cannot perform its function. In medicine, we call this “entrapment neuropathy” or nerve compression.

Carpal Tunnel Syndrome: The Trap in the Wrist

We encounter this type of nerve entrapment most frequently. A tunnel exists in the inner part of the wrist. We call this the “Carpal Tunnel.” Tendons bending the fingers pass through this tunnel. Additionally, a very important structure providing feeling to the hand, the “Median Nerve,” passes through here. However, bones and ligaments form the tunnel. Therefore, no expansion room exists. If tendons swell, the tunnel narrows. Eventually, the median nerve gets crushed in between. This situation consequently starts Carpal Tunnel Syndrome.

The median nerve remains very valuable. This is because it provides feeling to the thumb, index finger, middle finger, and half of the ring finger. If compression starts, life effectively stops in these fingers.

Symptoms: Your Body’s Warning Signals

The disease starts insidiously. Initially, you ignore it. But over time, it makes life difficult. Your body sends you the following messages:

• Night Numbness: This represents the most typical symptom. It wakes you up from sleep. Therefore, you shake and rub your hands. Finally, you relax when blood flow improves.
• Tingling Sensation: Tingling occurs especially in the first three fingers (thumb, index, middle). You feel as if electricity shocks you.
• Strength Loss: You struggle to hold a fork at breakfast. For instance, you drop a glass. Also, you cannot open a jar lid.
• Muscle Wasting: In advanced stages, the muscle at the thumb’s base wastes away. That area flattens. This indicates the nerve suffered great damage.
• Spreading Pain: Pain does not only happen in the hand. On the contrary, pain sometimes spreads to the arm, even to the shoulder.

Causes and Risk Factors

So, why does this tunnel narrow? Actually, no single cause exists. Usually, several factors combine. Here we list the most frequent causes:

Occupational Strain

People using their hands constantly and repetitively face risk. For example, computer users hold the mouse constantly. The wrist remains bent. Furthermore, carpenters, musicians, textile workers, and housewives form this group. Repetitive movements swell the tendons. Consequently, the nerve gets trapped.

Hormonal Changes

Especially the pregnancy period remains critical. The body holds water. Tissues swell. This edema narrows the tunnel. Usually, it passes after birth. However, sometimes it becomes permanent. In addition, thyroid diseases (goiter) and diabetes reduce nerve durability.

Anatomical Structure

Some people have a congenitally narrow wrist canal. The probability of seeing the disease increases in these people. The tunnel structure in women is narrower than in men. Therefore, we encounter it more frequently in women.

Diagnosis: EMG and Examination

When you apply to our clinic, we listen to you first. Then, we note your complaints. Subsequently, we perform a detailed neurological examination. Specifically, your doctor applies the “Tinel Test” or “Phalen Test.” He taps or bends your wrist. We suspect it if electricity occurs in your fingers. However, we turn to technology for a definite diagnosis.

EMG (Electromyography): It stands as the gold standard of diagnosis. We measure how fast nerves transmit electricity. If the nerve is trapped, electrical signals pass slowly through that region. Moreover, EMG tells us the location and degree (mild, moderate, severe) of the compression clearly. Thus, we draw the treatment plan. You can book an appointment immediately for a detailed examination.

Treatment Options: Is Surgery Necessary?

Not every patient undergoes surgery. We plan treatment according to the disease stage. For instance, if the compression ranks as “mild” or “moderate,” we try non-surgical methods.

Non-Surgical Methods

• Wrist Splint: You use this especially at night. It keeps the wrist in a straight position. Consequently, it relaxes the tunnel. It reduces the load on the nerve.
• Drug Therapy: We prescribe edema-reducing and pain-relieving drugs. Sometimes we add Vitamin B supplements.
• Injections: We inject steroids (cortisone) into the tunnel. This procedure disperses edema rapidly. It relaxes the patient. However, the effect remains temporary sometimes.
• Physical Therapy: We facilitate nerve movement with nerve gliding exercises.

The Gold Standard: Microsurgical Release

If your pains do not pass, you should consider surgery. Also, if muscle wasting started in the hand, you do not wait. Because a dead nerve cell does not come back. We, surgeons, apply the “Microsurgery” method. This method differs greatly from classic surgeries.

We perform it under local anesthesia. This means only your arm goes numb. Therefore, you remain awake. The procedure takes approximately 15-20 minutes. We enter through a very small incision (about 2 cm) in the palm. Then, we work under a microscope. Ultimately, we cut the thickened ligament (transverse carpal ligament) compressing the nerve. Thus, the tunnel roof opens. The nerve relaxes instantly. Finally, the pressure lifts.

Thanks to microsurgery, the risk of vessel and nerve injury decreases to almost zero. Recovery happens very fast. Consequently, the patient returns home the same day. Moreover, he starts using his hand the next day. The stitch scar disappears in the palm line.

Elbow Compression: Ulnar Tunnel Syndrome

Although not as frequent as carpal tunnel, it remains an important problem. It is the point known as the “funny bone” among the public. For example, electricity strikes when we hit our elbow somewhere. That is the groove where the “Ulnar Nerve” passes. You crush this nerve if you lean your elbow on the table constantly. Also, we see it frequently in those sleeping with their arm under the pillow.

Symptoms differ here. Specifically, numbness occurs in the little finger and ring finger in ulnar nerve compression. “Claw hand” deformity develops in the advanced stage. Its treatment resembles the carpal tunnel. First, we protect the elbow. If it does not improve, we rescue the nerve from the trapped place with microsurgery again. Finally, we change the nerve’s place if necessary.

Frequently Asked Questions (FAQ)

Does pain stop immediately after surgery?

Yes, most patients say the famous numbness pain ends the night of surgery. They sleep comfortably. However, if the nerve damage is old, full recovery and disappearance of numbness take a few months. Therefore, you must remain patient.

When can I use my hand after surgery?

We tell our patients “do not spare your hand.” Consequently, you start moving your fingers immediately after surgery. Moreover, you eat your own meal. You perform your daily tasks provided you do not lift heavy weights. Usually, we remove stitches after 2 weeks, and full return to normal life begins.

Does the disease recur?

If we release the ligament fully with microsurgery, the probability of recurrence remains very low (below 1%). However, it may recur if the surgeon performs inadequate surgery. Therefore, applying to an experienced neurosurgeon is very important.

What happens if I do not treat carpal tunnel?

Never say “I can manage.” If you do not get treatment, nerve damage becomes permanent. As a result, your thumb muscles waste away. You lose your gripping ability. You become unable to button a shirt or turn a key. Finally, early intervention saves the nerve.

Which doctor should I see?

Nerve entrapments are diseases of the nervous system. Therefore, you must apply to Neurosurgery specialists for diagnosis and surgical treatment.

For more scientific information, you can review this source: NIH – National Institute of Neurological Disorders