Arthroscopy Nisantasi

Ervus medianus, one of the two main nerves responsible of the hand/fingers movements and sensation travels along with nine tendons underneath a bridge called ‘’transvers carpal ligament’’. This bridge and bones on the bottom create a tunnel called ‘’carpal tunnel’’. For any reason if median nerve represents nerve symptoms such as numbness and/or motor inabilities this is called ‘’carpal tunnel syndrome’’. Although the reason for nerve compression cannot be found in most cases, hormonal changes, pregnancy, rheumatoid diseases, masses in the tunnel etc.. could ease to show up the symptoms. First symptoms can be felt mostly at nights. Numbness in thumb, index, long and (half of)ring fingers, clumsiness, pain(in the late stages) are main complains of the patients. In late cases, the muscle bulk between palm and thumb base lost its prominence. In time, the symptoms expand to whole day. The syndrome is generally diagnosed by physical examination and electrophysiological studies(electromyography - EMG). In cases which are doubtful about their etiology(the reason of the disease) additional radiological methods are required to reveal previous fractures or possible masses. In some cases wrist splints may lessen the symptoms. Steroid injections may decrease swellings around the nerve and help for diminishing the symptoms. Surgery is the treatment of choice for patients whose symptoms last more than 2-3 months despite conservative methods. The roof of carpal tunnel is opened to relieve compression to the median nerve. Some severe cases need neurolysis (releasing nerve sheet under microscope)as well. Endoscopic carpal tunnel surgery (closed method)may be applied in selected cases. Patients should know that all symptoms may not be eliminated in some severe and delayed cases.

Here is a layer of tissue,called fascia, under the skin of palm which helps to keep the skin from sliding around when we grip things. In some people, this tissue thickens and shrinks, and pulls on the skin and and on the fingers(figure 1 ). Dupuytren’s disease is observed usually in men over 40. Frequency is more in diabetic ones. Ring and small fingers are affected more. Any relationship between patient’s occupation and the disease is not proven. Swollen and bent fingers are seen in the examination. Extension is limited depending on the severity of the disease. Palmar noduls are typically painless. Sometimes it is confused with trigger finger at the early stages. Patients have serious difficulties in hand washing, hand shaking, wearing gloves etc…..  Progress rate changes from patient to patient. Existence of nodules is not an indication for surgery itself. Steroid injections on nodules may decrease the rate of progression in selected cases. If the angle between the affected finger and palm is equal or more than 70 degrees, surgery is considred. The affected part of the palm fascia and its extensions are removed. To be able to protect vital structures such as vessels, nerves and tendons is important. Sometimes skin grafts from other parts of the body may be needed. Wound care, massage, exercises and splinting is important to get the best result and prevent recurrence.