1 – What are the reasons justifying the need to release the median nerve through a skin incision? ?
– Explanations on the area à operate :
- What is the median nerve? The median nerve is one of the major nerves of the hand and arm. It originates in the spinal column and runs the length of the arm to reach the hand. It is responsible for the sensitivity and motor function of several parts of the hand, including the thumb, index finger, middle finger and half of the ring finger. The median nerve plays an essential role in coordinating hand movements and in the tactile perception of these fingers.
- What is the carpal tunnel?The carpal tunnel is an anatomical structure located at the base of the hand, on the palm side, near the wrist. It is formed by the carpal bones (the small bones of the hand at wrist level) at the back and by a ligament called the flexor retinaculum at the front. The median nerve passes through the carpal tunnel alongside the flexor tendons. When this canal becomes congested or compressed, it can lead to compression of the median nerve, resulting in carpal tunnel syndrome. This condition can cause symptoms such as tingling, numbness and weakness in the fingers and hand, particularly in the fingers from the middle of the hand to the index finger.
- Carpal tunnel syndrome occurs when the median nerve, which passes through the carpal tunnel at the base of the hand, is compressed or irritated. : the more often, it y a a tendinitis (also called tenosynovitis) from tendons flexors : the membrane synovial which surrounds visit tendons swells and the nerve median is tablet.
– Why the intervention is necessary ?
- Treatment begins with medical approaches, but if these are not effective, intervention becomes necessary to restore adequate space for the nerve.
- Medical treatment initially involves wearing a splint at night, followed by anti-inflammatory (corticosteroid) injections into the carpal tunnel.
- In advanced cases (where the patient often feels no pain in the thumb muscles), surgery is considered from the outset.
- Without intervention, the fingers will become insensitive and the thumb muscles will suffer paralysis and atrophy.
– Additional tests: The electromyogram (EMG) is the preferred test. In addition to confirming the diagnosis, it assesses the degree of nerve compression. This helps to decide on the appropriate treatment, either medical or immediate surgical intervention in the case of severe compression.
2 – The derorlement of l’intervention
- Anaesthesia: In most cases, local or regional anaesthesia is used.
- Technical procedure: The technique involves cutting through the retinaculum of the flexors of the carpus, making an incision on the medial side of the thenar crease. If inflammation of the flexors is present, a synovectomy may be performed simultaneously.
- Complications during surgery: Complications during surgery are rare, and mainly involve damage to the median nerve, although this is exceptional. Even after repair, this could leave serious after-effects. After the operation, there is a risk of hematoma, and rarely infection of the surgical site.
- Complications after surgery: Long-term complications include persistent pain around the scar and reduced hand-grip strength. In addition, the development of algodystrophy, a painful and inflammatory phenomenon requiring prolonged treatment, can complicate any hand surgery.
- Normal post-surgery follow-up: After surgery, the hand is kept in an elevated position with a sling until it is fully functional again. The light dressing remains in place until the sutures are removed. As soon as the patient wakes up, the hand can be used again, without getting the dressing dirty or wet.
3 – Your intervention at practice
- Preparation before surgery: Take a disinfectant shower the day before and the morning of surgery. Remove any nail polish or nail prostheses.
- Hospitalization: In most cases, the procedure is performed on an outpatient basis.
- Going home: After surgery, it is advisable to be accompanied on your return home, and not to stay alone the following night.
- Duration of work stoppage: The period during which work must be interrupted depends on the occupation...
