Carpal Tunnel Syndrome in Vienna
At night the fingers fall asleep, during the day buttons and keys slip out of your hand: in carpal tunnel syndrome the median nerve is under pressure at the wrist. At my practice in the Orthozentrum Döbling I look into the narrowing and discuss with you which treatment suits your findings.
In short
In carpal tunnel syndrome the median nerve is under pressure in a narrow canal on the flexor side of the wrist. Typical are the hand falling asleep at night and tingling in the thumb, index and middle finger, later a loss of strength when gripping and a thenar eminence that becomes flatter. I make the diagnosis from the consultation, the examination and ultrasound; a nerve conduction study confirms it. Treatment begins conservatively with a night splint, adjusted loading and, where needed, an ultrasound-guided injection. If the symptoms persist or the nerve is already damaged, I free it in a minimally invasive procedure, usually as day surgery.
What is carpal tunnel syndrome?
The carpal tunnel is a narrow passage on the flexor side of the wrist: the carpal bones form its floor and its sides, above them lies a firm band, the flexor retinaculum. The flexor tendons of the fingers and the median nerve run through it. This nerve carries sensation from the thumb, the index and the middle finger and controls part of the thenar muscles.
The tunnel cannot expand. When the tendon sheaths swell, the pressure rises and the softest of its contents gives way: the nerve. Its blood supply suffers first — that explains the complaints at night. If the pressure persists, nerve conduction slows down and the thenar eminence wastes away. Repetitive forceful manual work, vibrating tools, hormonal changes, diabetes, thyroid and rheumatic disease all favour it, as does a radius that has healed in a poor position after a distal radius fracture at the wrist. Often a second narrow point exists in the same hand, a trigger finger for instance.
Typical symptoms
- The hand falls asleep at night — tingling or pain wakes you, shaking the hand brings relief.
- Altered sensation in a clear area — thumb, index and middle finger, plus the thumb side of the ring finger; the little finger is spared.
- Radiating pain — from the wrist into the forearm.
- Clumsiness in fine grip — buttons, coins and keys slip away, handwork becomes laborious.
- Wasting of the thenar eminence — the muscle pad below the thumb becomes flatter; a late sign, and a reason not to wait any longer.
How I make the diagnosis
First I ask in detail: when do the symptoms appear, which fingers are affected, what do you do at work and in sport? I then test sensation in the individual fingers, the strength of the thenar muscles and fine motor control; holding the wrist flexed or pressing over the carpal tunnel often provokes the familiar abnormal sensations.
Ultrasound I use right away in the practice: it shows the nerve in cross section, its swelling immediately before the narrow point and space-occupying lesions such as a ganglion. A nerve conduction study (electroneurography) I arrange through neurology, and if a bony cause is suspected, an X-ray or an MRI as well. Telling the conditions apart matters: if mainly the little and ring finger fall asleep, cubital tunnel syndrome at the elbow is the more likely cause; where the picture is unclear, I work through the causes of hand pain systematically.
Treatment: conservative first
As long as the nerve shows no lasting damage, I begin without an operation. The first step is a splint that holds the wrist in a neutral position at night and lowers the pressure in the tunnel. Alongside it I look at the loading: how you grip, your tools, keyboard and mouse, breaks during repetitive work. Physiotherapy adds exercises for the gliding of nerve and flexor tendons; like exercise therapy, it is available in the same building at the Orthozentrum Döbling.
If that is not enough, I use an ultrasound-guided injection: under direct vision I place an anti-inflammatory medication at the narrow point. That can ease the symptoms and at the same time shows whether the carpal tunnel is the source. One thing I say openly: these steps lower the pressure, they do not widen the narrow canal. My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. How the invoice and its submission work in detail is set out on the page about billing in my private practice.
When an operation is necessary
The aim is to give the nerve room again. Through a small approach in the palm I divide the flexor retinaculum — the release of the median nerve. The tunnel becomes wider and the pressure falls; nothing is changed on the nerve itself. The procedure is minimally invasive and can usually be done as day surgery. Afterwards the fingers should be moved early, so that tendons and nerve glide and the hand does not stiffen.
I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare. Further procedures on the hand and wrist are set out in the overview of hand surgery in Vienna. Whether an operation is due, and when, follows the findings: how severely the nerve is affected, how long the symptoms have lasted and what you need in everyday life. We go through these points together; only then is the decision made.
Frequently asked
Frequently asked questions about carpal tunnel syndrome
Typically the hand falls asleep at night and you wake up with tingling or pain. The thumb, index and middle finger are affected; the little finger is spared. If clumsiness in fine grip or a weakening thenar eminence comes on as well, you should have the symptoms assessed promptly.
During sleep the wrist often bends, and tissue fluid is distributed differently than during the day. Both raise the pressure in the carpal tunnel, and the median nerve reacts sensitively to it. That is why the symptoms announce themselves at night first. This is exactly where a splint comes in that keeps the wrist straight.
Not always, but it usefully complements the examination. Consultation, clinical examination and ultrasound usually give a clear picture already. A nerve conduction study shows in addition how far conduction in the median nerve is delayed. Before a planned operation I usually have it carried out through neurology.
With mild symptoms that have not lasted long, the night splint is a sensible first step. It holds the wrist in a neutral position and takes pressure off the nerve. It does not remove the narrowing itself: if the symptoms persist or nerve damage is already apparent, the splint falls short.
Through a small approach in the palm I divide the firm band that bounds the carpal tunnel on the outside. This gives the median nerve room again; nothing is changed on the nerve itself. The procedure is minimally invasive and can usually be done as day surgery. I discuss the anaesthesia and the sequence of events with you beforehand.
Both are compression points of a nerve, only at a different site. At the wrist the median nerve is compressed, and then the thumb through to the ring finger falls asleep. In cubital tunnel syndrome the narrowing lies behind the inner side of the elbow; in that case the little and ring finger are affected. The two can also occur together.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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